The following article first appeared January 27, 2011 in the publication Payers and Providers.

Our Fear-Driven Regulatory Realm: One Event, Not Day-to-Day Reality, Pushed SB 1953

As the CEO of a small Los Angeles County hospital who has dealt in the past with the Office of Statewide Health Planning and Development, I read Jim Lott’s recent opinion “Is OSHPD an Obstacle to Growth?” with great interest.  Mr. Lott’s astute recap of both the potential behind SB 1953’s initial design and the corresponding shortcomings in its deployment was in my opinion insightful.

However, to cast the blame entirely on OSHPD is not necessarily fair, especially when it comes to state-mandated seismic safety standards.  In marshalling all California hospitals in the direction of SB 1953, OSHPD has been charged with a Herculean task, which has been compounded by our current economic climate. With such responsibility thrust upon the shoulders of an underfunded, understaffed department, efficiency was certainly never a priority in the minds of its makers. Furthermore, as important as this role may be, upon reflection it stems in large part from the fear generated by a high profile tragedy and the arguable overreaction of state policymakers and popular media.  Too often after these events the course of health care shifts its aim away from the big picture to dwell on anomaly, often to the detriment of both patients and providers.

To be certain, the isolated events that capture our attention are often devastating, tearing apart families, communities, even cities.  In early January an angry, disturbed young man killed six with his gun. Some of the victims were high profile and others were tragically young.  As the fallout from this shooting captured the nation’s spotlight, significant focus centered on episodes of unidentified bipolar disorder and schizophrenia.  Mental health experts trumpet the warning signs of illness leading to such a violent event much like Californians speak of “The Big One,” even though less than 0.004% of the U.S. population is likely to die from firearms each year.  When this occurs, the spotlight is shifted away from more prevalent threats such as diabetes, obesity, and heart disease, though the after-effects on the families of those who die from these understated killers are no less devastating.

Similarly, when fear of catastrophe sets the tone for policy, funding is often funneled away from its most deserving targets. The idea for SB 1953 came about after a 6.7 magnitude earthquake in Los Angeles County, California killed 72 people in January, 1994.  Seventeen years later, hospitals across California are spending their part of the estimated 90 to 120 billion dollars to ensure they meet the seismic safety requirements mandated by the state legislature, regardless of their day-to-day fiscal health.  While the Northridge Earthquake unquestionably caused tremendous damage to Southern California, the proposed price tag when broken down runs about $1.7 billion per fatality.

As an administrator, it is confusing to me that America’s health care is so often dictated by the after-effects of an aberrant, high profile tragedy, while more subtle yet more prolific killers go largely unpublicized as their cures remain underfunded and their victims die without fanfare, or essential, ear-marked funds are rerouted to assuage tomorrow’s fears. Seismic compatibility is a goal worth attaining, but in these troubled economic times as hospitals both large and small struggle to keep their doors open to a dependent public, it certainly does not hurt to understand the origins of this expensive overhaul, and question whether these funds would be better spent on preserving the quotidian rather than planning for a possible catastrophe.  By 2015 all functioning California hospitals should be prepared for the Great Shock, but how many will remain to be left standing, regardless of the whims of Mother Nature?