Boom in hospital renovation, thanks to quake.

Los Angeles-area hospitals are embarking on the most prolific building period in history.

The construction is everywhere, from massive rebuilding projects at St. John's Hospital in Santa Monica and County-USC Medical Center in Boyle Heights to new buildings at Glendale Adventist Medical Center, Long Beach Memorial Center and Childrens Hospital of Los Angeles.

All told, the 15-year period from 1995 to 2010 is expected to see $12 billion to $15 billion in hospital construction, according to Jim Lott, policy analyst for the Healthcare Association of Southern California, which is composed of local hospitals.

That's in sharp contrast to the previous 15 years, particularly the decade from 1983 to 1993, when almost no hospital construction took place, Lott said.

"From 1983 to 1993, hospitals were reeling from the impact of managed care," Lott said. "They were scrambling to maintain margins, so they didn't spend a whole lot of money on rebuilding facilities. Most couldn't get any lenders for projects until their books were more in balance.

"That's all changed now," he said. "Hospitals have downsized their staffs, and now there is a great need to redo facilities. Also, there has been a lot of money flowing in from FEMA (the Federal Emergency Management Agency) for earthquake repair that has sped along projects that had been stalled."

Last month, for example, the Santa Monica City Council approved plans for a $271 million rebuilding of quake-damaged St. John's Hospital and Health Center.

Also last month, a new and expanded $11 million emergency room opened at Cedars-Sinai Medical Center.

And last November, the L.A. County Board of Supervisors approved the construction of a 600-bed hospital to replace the quake-damaged County-USC Medical Center. The cost of the new facility is estimated at between $788 million and $907 million. Completion is set for 2004.

Also on the horizon is a massive rebuilding of the medical facilities at UCLA; $150 million will be spent on replacing UCLA Medical Center and another $400 million to $500 million on related medical and academic facilities by the year 2010, according to Medical Sciences Provost Gerald Levey.

There's also a host of smaller rebuilding projects in the works. More than $440 million either has been spent or received state approval to be spent on projects of $1 million or more, according to the Office of Statewide Health, Planning and Development.

Ultimately, each of L.A. County's 82 acute care hospitals (with emergency rooms) will have to lay out dollars for design and construction over the next 10 years. These facilities face a Jan. 1, 2001 deadline to submit plans to comply with tough new earthquake safety laws. The renovations must be completed by 2008.

Some facilities may only need walls reinforced or power generators and plumbing upgraded. Others may need an entire new wing or total replacement facility.

The hospital construction boom is bringing work to architectural and construction contracting firms.

"Our business has changed a lot. Back in the late 1980s and early 1990s, we would see small remodel and interim improvement projects at hospitals," said Douglas Graham, senior medical planner with the Santa Monica office of SMP-SHG, an architecture and planning firm.

"Now, we're seeing much bigger projects. We're designing entire replacement buildings or wings of hospitals," he said.

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Meanwhile, at JCM Group, a Los Angeles-based design and construction firm, hospital-related work has jumped from one-third of the practice five years ago to one-half today, with even more work coming down the pike.

"It's going to be a very brisk business," said JCM President Wayne Twedell. "We're going to be hard-pressed to find the right resources, both professional and construction equipment. There are very few people in the L.A. area with the expertise in hospital design and construction and there are some really big projects on the horizon."

Twedell was referring to the St. John's, County-USC and UCLA rebuilding projects.

Ironically, much of this construction would not have been feasible without the damage caused by the Northridge quake, which brought hundreds of millions of dollars in FEMA funds.

And that quake-triggered rebuilding could not have come at a better time. Hospitals today are faced with the need to adapt their facilities for managed care and new technologies, both of which reduce the need for overnight stays.

So hospitals are being rebuilt with fewer beds, more outpatient facilities, more high-tech equipment and wellness centers.

According to a survey of local hospitals conducted by the Healthcare Association, when all these projects are completed over the next 15 years, there will be 28 percent fewer hospital beds in L.A. County than there are today.

"We are carrying a lot of bed capacity that we don't need," Lott said. "Hospital occupancy rates in L.A. County have dropped from 75 percent in 1983 to below 50 percent today. So, the hospitals are using this opportunity to create facilities that are smarter and can be run more efficiently."

For example, the new inpatient center, which comprises the first one-third of the St. John's Hospital replacement project, will only have 150 beds - each in a private room - instead of the 317 licensed beds of the current facility, according to Terry Muldoon, vice president of engineering and support services at St. John's. (Before the Northridge quake, St. John's had 501 licensed beds.)

The remaining two-thirds of the replacement project will be devoted to outpatient facilities, including operating rooms, short-term recovery rooms and space for the latest high-tech medical equipment.

"This is a major shift from the past for us," Muldoon said. "More and more health care is being done on an outpatient basis. Five years ago, gall bladder surgery would have required a two- or three-day hospital stay: with today's laproscopic surgery, the patient can usually leave on the same day."