California hospitals will spend about $100 billion before 2013 in order to meet state seismic safety standards. On top of that, the nationwide mortgage and credit crisis more or less doubles that $100 billion price tag in the event that these hospitals do not have the cash on hand. With construction expenses reaching an all-time high, a 100 bed hospital may spend close to $100 million to build a replacement facility. That same facility will be lucky to break $50 million in revenue (not profit) in any given year.
This incomprehensible financial dilemma, only five years away but the result of a shifting in the earth's core somewhere around Northridge in January 1994, is yet another example of inconsistent public policy concerns converging in the health care sector. If this $100 billion expense was not bad enough, hospitals now face increasing pressure to be more "green."
Caught in the middle of a financial crisis, a healthcare crisis, a gas crisis, an ever-present earthquake crisis, and now an environmental crisis, will tomorrow's hospitals in California be yesterday's 8-track tapes? While the ultimate fate of California's hospitals has yet to be written, there are a handful of facilities throughout the state actually trying to be both seismically sound and green.
Mills-Peninsula Health Services' new facility just two miles from the San Andreas fault line will spend more than $500 million to be perhaps the most seismically safe hospital in the country. On top of that, the Burlingame, Calif., facility will also be one of the state's "greenest." Using friction pendulum bearings, the new medical center will be able to move up to 30 inches horizontally and 2 inches vertically without suffering any major damage in an 8.0 magnitude earthquake. But the 176 bearings positioned between the foundation and the columns in the building is not the top story. Instead, the hospital's sustainability, complete with cool roofs, low-VOC (volatile organic compounds) materials and finishes, furniture and other fixtures made from recycled materials, high powered solar energy to make things warm and cold, and a ventilation system relying upon fresh air is the real story.
Hospitals around the country are starting to realize that eco-friendly means good business. Some hospitals are eliminating water bottles, while others are purchasing hybrid vehicles. Most facilities recognize the benefits of switching to energy-efficient lighting, provided they are mindful how they eliminate the excess mercury in the process. But what about the $100 billion seismic bill?
Brand new facilities replacing older hospitals are sprouting up all over the state. Very few mention the environmental upgrades included in this investment, and most are finding an easy exemption to California's "Green Code" (contained within the California Code of Regulations, Title 24, the applicable portion is known as the California Green Building Standards Code). One exception to this familiar pattern is Kaiser Permanente, which has an environmental committee that influences its construction decisions. Kaiser plans on spending close to $24 billion over the next several years, and 30 million square feet of this new construction will come from "ecologically sustainable materials". In fact, the example Kaiser is setting coupled with the number of Kaiser-facilities affected statewide has helped make eco-friendly materials more affordable.
While Kaiser's efforts should be applauded, the unfortunate reality is that state seismic requirements do not necessarily comport with environmental concerns. LEED certification, the leading guidelines for environmentally-smart building, is used primarily for commercial office space and does not translate well for most hospitals in use 24 hours a day, seven days a week. Green construction under the LEED program recognizes excellence in five areas: (1) sustainable sites; (2) water and (3) energy efficiencies; (4) materials selection; and (5) indoor environmental quality.
The enormous amounts of energy and water used by hospitals puts the health care sector near the top of the list for consumption. Patient safety issues aside, recent estimates calculate that LEED-certification will also add an additional 5- 7 percent to the cost of meeting the seismic safety laws. The federal government's "Green Guide for Healthcare Construction" ("GGHC") is designed to help hospitals navigate through the LEED program and places more of an emphasis on materials and purchasing as well as the handling of hazardous materials. The "Green Building Initiative" ("GBI") challenges state government to demonstrate leadership in energy efficiency and environmental responsibility in state buildings, while also reducing the impact state facilities have on climate change. The GBI requires states to reduce grid-based energy as much as 20 percent by 2015 and carbon emissions by 1.8 million metric tons before 2020.
No question, green construction in the hospital setting has good intentions and is designed to protect patient health, as well as hospital employees and visitors. But some eco-friendly changes may actually compromise patient care. Increasing natural airflow may spread airborne diseases. Too much of a reduction in the use of water can increase hospital infections. Still at the forefront, Kaiser is testing a displacement ventilation system that "introduces air at floor level and uses the natural buoyancy of warm air to remove particulates" and may reduce energy expenses by 40 percent. Kaiser has confirmed that this system will not be used until it is found to be both safe and effective.
California hospitals often find themselves at the crossroads where difficult and inconsistent public policy concerns meet. These problems extend well beyond the discussion above. For now, there should be a balance between the seismic safety challenges California hospitals now face and the public pressure to be more sensitive to environmental concerns. Without some compromise, California hospitals may very well reduce their carbon footprint completely. Being non-existent, however, is not really another way of saying "off the grid."
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