Extensions for retrofit requirements leave hospitals vulnerable to quakes.

Just how would L.A. hospitals fare if they were hit with an earthquake that caused the kind of devastation that overwhelmed hospitals in New Orleans?

For some, very well. For many, probably not well at all.

After the 1994 Northridge earthquake, which damaged two dozen hospitals and forced the closure of Saint John's Health Center in Santa Monica, the state enacted a law requiring hospitals to retrofit their facilities by 2008 to remain standing after a major temblor. Stricter standards set to go into effect in 2030 require them to remain operational after such a hit.

That law has prompted a massive boom in hospital construction, both statewide and locally, where at least 11 hospitals in Los Angeles County are either being built or renovated at a total cost of $3.2 billion. That includes a new L.A. County/USC Medical Center, a new hospital at UCLA, the continuing reconstruction at Saint John's and several new Kaiser Permanente facilities.

But the law has allowed hospitals to seek delays from the first deadline until 2013. At least 55 hospitals in the county, most pleading economic hardship or logistical challenges, have been able to get extensions, according to the state's Office of Statewide Health Planning and Development, which approves hospital construction projects.

Industry officials maintain that those figures are understandable, given that the total cost of meeting the law could range from $24 billion to $40 billion statewide.

"It's a huge challenge for all the hospitals in the state, especially when you consider that (even) the lower end of that estimate is higher than the asset value of the hospitals," said Jan Emerson, spokeswoman for the California Hospital Association.

The industry has learned that it is not cost effective in most cases to retrofit hospitals to meet the 2008 deadline, only to have to strengthen their facilities to meet the 2030 regulations. Most hospitals now simply plan to renovate or rebuild to meet the stricter regulations.

Those standards are designed to make hospitals one of the safest places to be in a Northridge-type earthquake, which resulted in some of the strongest ground movements ever recorded. The detailed regulations require equipment to be safely secured, and for the hospital to remain fully functional afterwards.

Kaiser Permanente, which expects to spend $7 billion in Southern California alone building new or renovated hospitals, is building a new inpatient hospital at its main Sunset Boulevard campus and adding patient care towers at its West Los Angeles, Panorama City and South Bay hospitals.

While Kaiser has received extensions for several of its Northern California hospitals, it only expects one Los Angeles facility not to meet the deadline. Its Bellflower hospital will be replaced by a new Downey facility that will be completed by 2013 but after 2008.

"It's a financial challenge for everyone involved. We can certainly understand the challenges other hospitals are facing," said Kaiser regional spokesman Jim Anderson. "But we're a large institution with a long history in Southern California and we plan to be here for a long time to come, so when the law was passed we decided we'd figure out how to do it."

UCLA Medical Center is building a new $400 million facility to replace its 50-year-old hospital. The new hospital, which has been hit with some construction delays, is scheduled to open in 2007.

Cedars-Sinai Medical Center has built an assortment of facilities over the past decade. A $110 million critical care tower, set to open in December, will meet the 2030 standards, but the main hospital tower, which dates from the 1970s, only meets the 2008 standards, said hospital spokesman Richard Elbaum.

Other major hospitals in Los Angeles that have extension requests until 2013 approved by the state include Queen of Angels/Hollywood Presbyterian Medical Center, Glendale Memorial Hospital & Health Center, Long Beach Memorial Medical Center, California Hospital Medical Center, Brotman Medical Center, St. Vincent Medical Center, Citrus Valley Health Partners, Good Samaritan Hospital and Downey Regional Medical Center.

Centinela Freeman Health System, which includes three hospitals divested by Tenet Healthcare Corp., is typical of many of the facilities seeking delays. The health system intends to complete the seismic retrofits, but wants to do them in conjunction with other planned renovations to lower the overall cost, said business development director Cyndee Woelfle.

The passage of stricter seismic standards after the 1994 Northridge Earthquake is not the first time that the state has tightened construction requirements for hospitals. The 1971 Sylmar earthquake caused the collapse of two hospital buildings, killing 65 people.

That prompted the state to approve stricter standards in 1973 that required all new hospitals to be designed to withstand a major earthquake and remain operational immediately afterward.

But it did not require hospitals to retrofit their existing facilities, and with many hospitals having a useful life of 30 to 40 years, the Northridge Earthquake damaged many older facilities that were constructed prior to 1973.