Care providers' mettle tested in aftermath of quake; they treat 9,300 casualties, assess damaged structures.

They treat 9,300 casualties, assess damaged structures

When a major earthquake rocked the Southland last month, neo-natal nurses at Saint John's Hospital and Health Center in Santa Monica grabbed newborns out of the nursery as plaster cracked and bricks crumbled around them. At nearby Santa Monica Hospital Medical Center, the backup power generator failed, forcing personnel to work in pitch blackness. Dr. John Plosay, the doctor in charge of the emergency room when the quake struck Jan. 17 at 4:31 a.m., used the headlights of a police car positioned just outside the emergency room door to treat patients, including one heart attack victim who didn't survive.

"When it's dark, it makes any experience more frightening," he said. "You're doing primitive medicine."

Across town at the Los Angeles County Olive View-UCLA Medical Center in Sylmar, hospital personnel plodded through water from burst pipes and evacuated patients off two severely damaged floors.

All around Los Angeles, the temblor, which registered 6.6 on the Richter scale and caused more than 9,300 casualties, created havoc at dozens of medical facilities and hospitals. Public officials have called for even stronger seismic safety laws in the aftermath.

In all, 20 hospitals reported quake-related damage, according to the Office of Statewide Health Planning and Development in Sacramento, the state body responsible for overseeing hospital safety and information.

Nearly all of those hospitals suffered damage so extensive that they were forced to shut down completely or sharply curtail services. About 1,000 patients had to be evacuated from quake-damaged hospitals and more than 2,500 beds were lost within the first few days.

Hospitals were inundated with patients, as overwhelmed medical personnel scrambled to provide treatment. More than 7,700 patients were treated and released from emergency rooms following the quake, according to the Hospital Council of Southern California. Another 1,496 were treated and admitted for inpatient treatment. In L.A. County, 57 people had died from quake-related circumstances as of the first week of February.

Scores of smaller medical facilities, such as Cigna HealthCare of California's Granada Hills building, had major structural damage and may never reopen. Cigna's Granada Hills employees were forced to find work in other hospitals or volunteer at shelters.

Common structural damage at Southland health care facilities included buckled concrete, shattered windows, steel rods protruding from crumbled walls, splintered doorways and cracked floors.

Mechanical system failures also crippled hospitals. Water mains sprang leaks and ruptured, electricity failed, causing elevators and generators to go down. Phone lines died, oxygen lines broke and bolts broke off equipment that had been anchored to the floor.

Some of the worst-hit health care facilities were nursing homes.

Bay Vista Convalescent Hospital in Santa Monica was rocked off its foundation and will have to be demolished, according to state officials. Berkeley East Convalescent Hospital in Santa Monica had a structural wall collapse, rendering the entire building unsafe. Officials estimated the building would take nine months to fix.

Hallmark Nursing Center in Simi Valley sustained a major crack through the entire building and its foundation crack and shifted. A reopen date for that facility had not been determined by press time.

Several hospitals are expected to be partially or completely incapacitated for months.

Saint John's Hospital, for instance, can render only outpatient services. Its north and south wings have been "red-tagged" by city building inspectors, indicating the structures are unsafe to enter. Its main wing is "yellow-tagged," which means structural engineers are still evaluating the building. St. John's plans to reopen its south wing in August and demolish and rebuild its north wing. The new north wing will be much smaller than the pre-existing wing, however. The hospital, which had 375 beds operational on the morning of the quake, 307 of which were occupied, plans to have only 140 to 150 beds when its rebuilding is complete. St. John's is licensed for as many as 501 beds, but only 375 of those were operational at the time of the quake due to lack of demand. Even before the quake, St. John's had instituted a three-year plan to phase out many of its beds and build in their place a new outpatient facility.

"Hospitals used to be built for a five-day stay after having a baby; for knee surgery you stayed in the hospital," said Gary Miereanua, a St. John's spokesman. "Now women go home a day after giving birth, and knee surgery is done on an outpatient basis. There will always be a need for beds, but not as many as in the past."

According to a state report, more than two-thirds of hospitals in California don't meet the latest seismic safety standards that were instituted statewide in 1973, in the aftermath of the 1971 Sylmar earthquake.

"The problem, of course, is money," said David Langness, a spokesman with the Hospital Council of Southern California. "More than half the hospitals in California are in the red. It will cost tens of millions of dollars (to seismically upgrade local hospitals to code). We need to find a funding source." Langness has joined a host of high-profile health care professionals in support of state legislation to toughen earthquake safety laws. Among those professionals are Tim Priselac, president of Cedars-Sinai Medical Center in Los Angeles, which sustained major structural damage to its parking garage and one research building; Dr. Richard Corlin of the California Medical Association, and Kathy Carder, a nurse in the critical care unit of Santa Monica Hospital who is also a representative of the California Nurses Association. Legislation being urged by Assemblyman Burt Margolin, D-Los Angeles, chairman of the Assembly Health Committee, would require older hospitals to be retrofitted to meet the same stringent requirements demanded of hospitals built after 1973. Margolin also wants to toughen the standards for hospital mechanical systems, such as backup generators. Among those tougher standards would be a requirement for more frequent inspections of such systems.

"The Northridge earthquake reveals rather dramatically that seismic safety laws are just not tough enough," said Margolin, who is running for state insurance commissioner. "In the aftermath of an earthquake, we need hospitals to stay open for business. We need to guarantee they keep their doors open."

To ease the financial burden, Margolin is proposing that the required retrofitting be phased in over 10 to 15 years.

"With health care reform, many hospitals are already making decisions to close buildings, close wings," he said. "Since they're already closing and merging anyway, we want seismic safety to be a part of this. If we would have done this in 1973 ... much of the work would have already been done."

One place where safety standards have been upgraded is at the Olive View-UCLA Medical Center in Sylmar.

During the 1971 quake, three people were killed when an 888-bed, one-month-old hospital came tumbling down. A 377-bed replacement Olive View-UCLA hospital was built on the site in 1987, under the stricter seismic safety codes instituted in 1973.

In last month's quake, the hospital's non-patient buildings were severely damaged and have since been red-tagged. But all patient areas at Olive View-UCLA have been green-tagged and are fully operational.

"We've figured this stuff out -- not completely -- but better than before," Langness said. "As a result, we're saving a lot of lives."

Langness said the earthquake will hurt the health care industry in the short term, but not in the long term. In Los Angeles County's 148 hospitals, about half of the 31,300 acute-care beds are empty, he said.

"We were able to transfer almost 1,000 patients because L.A. has so many (empty) beds on any given day," said Langness. "This isn't a desirable way to deal with our over-bedding problem, but the system will be able to absorb (displaced patients)."