Hospital tower progress in Tulare stays well ahead of looming deadline

The recent uptick in construction at the hospital tower project in Tulare is a sign of good things happening there with much more to come, says Tulare Local Health Care District (TLHCD) CEO Randy Dodd. And it’s just possible, he said, that the district already has enough money on hand to finally get the building open for medical services.

It might even be possible to extend the life of the 1950s-era main hospital building – now occupied and managed by Adventist Tulare – beyond the looming 2030 state deadline for seismic upgrades to hospitals across California, Dodd said.

But it won’t be easy.

State’s Seismic Hardening Deadline is January 1, 2030

By the first of the year in 2030, every hospital in California must be able to continue providing medical services following a major earthquake. The deadline is not a new one, and meeting it has proved difficult for many hospitals, putting them under the gun. That’s where the TLHCD found itself in 2023, with the Tower Expansion Project stalled and funding in short supply.

“That was a concern about a year and a half ago or two and a half years when I got here,” Dodd said. “We were turning a screw every month just trying to keep the project alive.”

But not anymore. The state did complain about the lack of progress not long after Dodd took over as CEO in February 2023, and the expansion project was at the point it could have been decertified by the state. The state regulators, it turned out, were eager to help the TLHCD get back on track.

“I told the state we’re doing the minimum we have to. They said, ‘Tell me what you can do,’” Dodd said, and he did, giving them a list of partially completed work. “They said, ‘Great, we want you to go to work on that.’”

So the district got busy, and work is underway now that could see new operating rooms and a new emergency department open in the not-too-distant future.

District Focused on Readying New Operating Rooms

Construction underway now – or about to be underway – will make the entire building fit to house the demanding work done in a hospital setting. However, the goal is not getting the entire tower finished at once. The more immediate goal is getting the second floor – given over to a suite of state-of-the-art operating rooms – open for the surgeons and staff of Advenist Tulare.

Installation of exterior stairs is nearing completion, and work on finishing the interior walls is making good progress, Dodd said. The materials for some of the work being done now, like stocks of drywall, were purchased as long as 10 years ago and sat unused since the project stalled.

Other projects – like making final adjustments to elevators, and rewiring and reworking the dumbwaiter system – have required spending by the TLHCD Board of Directors. At their latest meeting in July, the board approved about $80,000 to cover those costs. Also on the upcoming work schedule is installation of a centralized monitoring unit (CMU) in the new ambulance bay. A CMU is an alert system providing oversight of hospital operations.

The tower’s helipad construction plans are pending while the district waits for state approval. Other basic utility infrastructure is incomplete, though plans to finish it are in place.

“Once we have fire suppression through the building, we can do the electrical, the gas lines and the plumbing,” Dodd said. “We’re trying to phase it all in.”

Reevaluation Led to Discovery of Cost Saving

Only after preliminary work is complete can the second floor and its operating rooms become the central focus of the project. When the project leads went over the planning work done by those who managed it before them, they found a source of encouragement. The companies that had originally designed and developed the project, Dodd said, had overstated the cost, and finishing the tower will likely cost significantly less than once thought.

“It’s not going to be a $1,000 square foot project,” said Dodd. “We went back, and we should be at half to three-quarters of that cost for the project.”

And that means the tower could soon be open for business, at least in part.

“I have enough cash to finish one floor,” Dodd said. “That’s not ideal, but we can get the second floor ready for Adventist’s doctors.”

The current estimate to finish the tower is $100 million, according to the TLHCD. That number is down by $25 million from estimates given by TLHCD President Kevin Northcraft in 2023 when Dodd took the CEO position. They’ll spend part of that budget soon, as the district is seeking bids of the utility work now.

“When those bids come back, we can evaluate getting those (jobs) started,” Dodd said. “We really want a general contractor overseeing what needs to be done.”

Seismic Deadline Still Looms Ahead

Despite the general progress on tower construction, the seismic deadline is still fast approaching. It has created a sense of urgency at the TLHCD.

“We’re trying to move fast on the tower,” Dodd said.

But their close relationship with state regulators and legislators means there’s still about seven years of margin.

“It’s almost an absolute we’ll get an extension to 2033,” Dodd said, adding that he thinks it likely the state will extend the deadline further into the future, as it’s already done before. “I think the state is going to kick the can down the road. There are a lot of hospitals that can’t meet that requirement.”

Adventist Tulare is one of those hospitals. The buildings housing it now were constructed some 70 years ago, and the original plans for expansion included a pair of multistory towers to replace it entirely. Now, there is no chance a second tower will ever be built, and expensive upgrades are necessary in order to make the 1950s-era main hospital building earthquake-ready.

But it might happen, again thanks to assistance from the state.

“The foundation is the biggest issue on the 1950s building,” Dodd said. “The state is going to pay 90% or more of (the cost of) the assessment on that.”

The building’s casements and sheer walls must be evaluated for stability and to assess the minimum amount of bracing they’ll need to meet modern seismic standards. The possibility at this point is a longshot.

“That’s a big what-if,” said Dodd. “We’re going to complete an analysis to see if it’s doable. I need the new ER and OR to make it work.”

Tulare Not Alone In Struggle to Meet State Seismic Requirements

According to Dodd, TLHCD’s situation is typical. They face costly improvements they can’t afford. And, he said, state leaders are aware California’s major medical facilities will fail to meet the 2030 deadline.

“All the hospitals are struggling to meet this,” Dodd said. “The state has even acknowledged this. They don’t even have the staff to review all the work that needs to be done. And there aren’t enough laborers. This is an impossible task to complete on time.”

Yet Governor Gavin Newsom vetoed a bill passed by both houses of the state legislature that would have given hospital operators more time to comply. Dodd thinks Newsom used his veto to keep progress on upgrades from stalling.

“I don’t think they want to change the law yet to push this as hard as they can,” he said.

And for hospitals in the Southern San Joaquin Valley, seismic preparedness is not the critical issue it is elsewhere, as in the Bay Area or Southern California.

“I sat down with legislators and asked if you’re going to shut this (Adventist Tulare) down if we can’t comply,” Dodd said. “This is on the one-off chance we have a seismic event here. We’re nowhere near a major fault.”

The geology of this area makes a major earthquake here unlikely. But it could happen.

“If we did have an event, it might mess up the plumbing and we’d be shut down for a day,” said Dodd. “That as opposed to shutting us down forever? Some (lawmakers) just look at you and nod and say yes. Others get it, that this doesn’t need to happen.”

Promises Kept

Despite this ongoing statewide struggle, one that could soon blossom into a full-blown medical crisis, Dodd is optimistic for the future of health care in Tulare. He wants those who rely on the district and Adventist Tulare to share his good feelings.

“I think the public should be excited,” Dodd said. “We’re making progress on a promise that was made 15 years ago. We’re doing our level best to be efficient with the money that is provided to us and moving the needle on all the assets and resources that are available to us to serve everybody.”

The tower expansion project finally has real momentum, Dodd believes.

“We’re anxious to keep it going,” he said. “We want people to know there are good things coming.”