Quake forced hospitals to mull alternative facilities.

The 1994 Northridge earthquake shook up Los Angeles area hospitals - in more ways than one.

There was, of course, substantial damage to many hospitals, including several in the San Fernando Valley.

But the quake and the resulting legislation - which requires every hospital to submit a seismic retrofit plan to the state by the year 2000 - has forced hospitals to reevaluate their facilities and operations.

And hospitals are using this as an opportunity to jump on the wellness bandwagon, planning for fewer permanent beds, more outpatient clinics and illness and lifestyle centers.

"For a long time now, hospitals have been upgrading specific units - like the intensive care unit or the radiology unit - to incorporate the latest technology. But it was always regarded as too costly to rebuild entire structures," said Melinda Eppler, a spokeswoman with the Office of Statewide Health, Planning and Development, which oversees hospital facilities. "Now, for the first time ever, many of these hospitals are doing some long-term planning for their structures."

That reevaluation, says Jim Lott, senior vice president of the Healthcare Association of Southern California, is dovetailing with the relentless trend toward downsizing traditional hospital bed units and the expansion of outpatient facilities - both hallmarks of the wellness movement.

"Where hospitals might have procrastinated in their response to the marketplace because of the expense involved, this requirement adds impetus," Lott said.

The Healthcare Association estimates that the total hospital retrofit price tag at $20 billion statewide and $8 billion for hospitals in Los Angeles County.

One of the hospitals hardest hit by the Northridge quake was Holy Cross Hospital - now Providence Holy Cross Hospital - in Mission Hills. The main hospital and an adjacent building on the north side suffered major damage and the north building was condemned.

Providence Holy Cross is now planning the $11.5 million rebuilding of the north building with more space devoted to outpatient services and wellness programs, said spokeswoman Sue Wyninegar.

Specifically, the north building will have conference rooms for community outreach meetings and more space for screenings.

The hospital is planning for a further expansion of its wellness programs by having additional meeting sites in a medical building across the street. Also, Wyninegar said, the hospital is setting aside space for community meetings and screenings in its cancer center. As a newer building, the cancer center received little damage in the quake.

The main hospital building, with its emergency room and one of the San Fernando Valley's two trauma centers, has been rebuilt largely the way it was before the quake. The cost of the rebuild was $27 million, including some funds from the Federal Emergency Management Agency.

Meanwhile, at nearby Valley Presbyterian Hospital in Van Nuys, a redesign is under way in response to the state legislation that will see more emphasis on wellness. The new hospital plans call for reduced acute care beds and more space devoted to outpatient services, according to vice president of corporate development Hal Wurtzel.

The hospital was severely damaged during the quake; however, the immediate repairs were not focused on increasing wellness facilities. which already included screenings and education centers Wurtzel said.

At St. John's Hospital and Health Center in Santa Monica, which was severely damaged during the Northridge quake, officials plan to rebuild the entire medical center, at an estimated cost of $285 million. Part of that cost includes a $15 million to $25 million wellness center.

"We are building from the ground up for a health center for the 21st century," said Sister Marie Madeleine Shonka, president and CEO of St. John's.

The new wellness center would include existing programs, such as a class catering to 2,000 area seniors called "Teaching Lifestyle Changes."

The center would also feature physical activity classes, Sister Shonka said.

"We now know that moderate physical activity at all stages of life is beneficial," she said.

The rest of the hospital will have only 150 beds, each in private rooms, down from the current 225 beds.

At Los Angeles County-University of Southern California Medical Center, the move is toward fewer permanent beds and more outpatient facilities, with one important difference: the outpatient sites are being placed in various communities and not at the central hospital.

And while the Northridge quake may have sped up the process with an injection of $488 million in Federal Emergency Management Agency funds, the county-run hospital's near financial meltdown in 1995 has been the main driver of this push toward wellness.

As part of a federal waiver, the hospital was ordered to move toward managed care and community-based care.

"By moving primary care out into the community, that frees up the hospital for trauma and acute care cases that had been overloading our system," said Larry Calvin, director of health facilities for the county Department of Health Services.

The primary care facilities are run by public-private partnerships and feature wellness programs, including immunization shots and prenatal care.

Meanwhile, the actual size of the replacement hospital is still being debated by the hospital's board, with a decision due around the end of the year, Calvin said. Currently, the hospital is budgeted for 837 beds, down from 860 in the 1996 - 1997 fiscal year ending June 30.

"We were ordered to reduce our inpatient beds by one-third, so the number of beds will definitely have to go down further," he said.

The board first looked at housing 950 beds; the latest proposal calls for a maximum of 750 beds.

Meanwhile, another public facility damaged by the earthquake has taken even more dramatic action. The federal Veterans' Administration building in North Hills, which was not far from the epicenter, was closed down completely. It reopened as an outpatient clinic, focusing on primary care and wellness programs.

"The Veterans Administration looked at the total beds in the Los Angeles area and concluded there were enough beds. So they decided to create a large outpatient center instead," said Michael Ross, an architect with the Los Angeles office of Stone Marraccini Patterson, who helped design the new clinic.

"We built a large three-story atrium where the landscape was brought inside the building. The idea was to make it less antiseptic and institutional and leave patients with a more warm feeling inside," Ross said.