Expand and refit, or go out of business. That’s the choices faced by the Kaweah Delta Medical Center.
In 1994, the magnitude-6.7 Northridge Earthquake shook Southern California, leaving devastation in its wake. Among the buildings damaged or destroyed were 11 of the area’s hospitals, rendering them unable to care for the wounded, as well as for patients already in their care, when disaster struck. In response, the State Legislature put new seismic regulations in place, giving all of California’s hospitals until 2005 to ensure their emergency rooms and acute care facilities would be earthquake proof.
For Kaweah Delta, a relatively small institution in an area historically free from major quakes, the new regulations presented a challenge it simply could not meet. Extensions and exemptions were granted, giving the district until 2030 to comply, but now that deadline is looming on the distant horizon.
Fortunately, the Kaweah Delta Health Care District has a plan.
“We need the community to understand we’re replacing the hospital,” said KDHCD CEO Lindsay Mann. “It will be fully a replacement of the Mineral King Wing.”
No longer good enough
SB1953, the law passed after the destruction of the Northridge Quake, requires emergency rooms and acute care facilities be “standing and fully functional” in the aftermath of a major trembler. For the Mineral King Wing, the hospital’s original building that was opened in 1969 and still houses 273 acute care beds, the requirement signaled the end of its useful life as a hospital.
“They (the state) have determined emphatically we cannot use the Mineral King Wing for acute care,” Mann said. “It needs to be standing and fully functional. Standing is different from fully functional.”
While KDHCD’s leadership lobbied Sacramento for further exemptions and more time, they were not idle at home. The medical center expanded to the west in 2004 with a multistory building at West Street and Mineral King Avenue, and the new Acequia Wing — containing many of the center’s state-of-the-art treatment labs, operating rooms and its expanded ER — was opened in 2009. The hospital additions made so far add 308 patient beds, and while this might seem like an adequate response to the new seismic requirements, it actually falls far short, Mann said.
“You need all the support services,” he said, “operating rooms, pharmacy, the labs, even dietary. You might survive a disaster, but after three days people are going to want something to eat.”
Many of those support services could be housed in the Mineral King Wing, but the cost of retrofitting former patient rooms into offices and labs may prove prohibitive, while the newly opened wings simply don’t have room for them. So, a 10-year plan has been devised that will give Visalia and the surrounding communities the care they need, provided voters agree to help foot the bill.
Renaissance Already Underway
KDHCD is already well into planning the expansion it must have to continue functioning, with their consultants already at work to define the scope, timeline and cost of the project. That preliminary work should be complete by the end of summer, Mann said.
“We will have what will lead to architectural plans,” he said. “Not just foggy generalities. We’re going to know.”
Following project scoping, the design process will take two years to complete, followed by another two years for the state to approve the plans. The remaining six years of the 10-year plan will be given over to the bidding process, construction and finally occupying the new building well within the 14 years remaining before the hospital must be in compliance with SB1953.
But, all of that is predicated on being able to pay for the expansion. The district, Mann said, has a plan for that, too.
Because the district knew it would have large future expenses associated with the expansion and refit, it’s been saving its pennies and will use its reserves to start the project. And, said Mann, the district, because of that financial acumen, has been given an A3 stable bond rating by Moody’s Investment Service, which it will use to issue bonds against its future reserves.
“It’s really a forever thing,” Mann said of the district’s financial health. “We’ve focused on being financially strong as long as I’ve been here, 37 years. It’s bedrock to what we’re doing.”
Going to the Voters
The district will also seek out grants from state and federal agencies, and will be looking for donations, such as those that paid for the medical center’s new helipad and it’s robotic surgery center. But, even with those sources, the cost of the new construction will exceed the district’s resources, forcing it to turn to voters for approval of general obligation bonds. That vote will require a better than two-thirds approval, and Mann is counting on the public to see the absolute necessity of passing the issue.
“At 67 percent, people have to have an inspired view of this being their hospital,” he said. “Another driver is that it is equally important to provide services you find in the Mineral King Wing.”
With KDHCD continuing to expand the services it provides to Visalia and surrounding communities, there is also a need to expand capacity at the medical center while maintaining high standards of comfort, safety and quality of service.
“The vision that drives us is elevating the services available at Kaweah Delta,” Mann said.
Relying on Past Performance
That voters might be hesitant to tax themselves is something Mann understands, but he believes those concerns should be offset by the district’s track record.
“We have a theme of doing these projects on-time, on-budget,” he said. “The entire West Campus (KDHCD’s cluster of medical facilities at Akers Street and Cypress Avenue) was built on-time, on-budget.”
KDHCD, he said, is well aware of its responsibility to continuing to provide the care residents within its boundaries must have and have counted on for decades.
“We understand the sacred trust with the community,” he said. “We have delivered, and we will deliver.”
But, that can only be done with the support of two-thirds of voters. Should they fail to fund this replacement of the Mineral King Wing, Visalia and surrounds will find itself without a medical center.
“We would not have a hospital to provide services to the community,” Mann said. “It’s just a fact.”