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<div class=Section1>
<p class=MsoNormal><span style='color:#1F497D'>Zhenming, et al:<o:p></o:p></span></p>
<p class=MsoNormal><span style='color:#1F497D'><o:p> </o:p></span></p>
<p class=MsoNormal><span style='color:#1F497D'>I agree whole heartedly. I
would only add that each community should be free to make their own seismic
mitigation policy. <o:p></o:p></span></p>
<p class=MsoNormal><span style='color:#1F497D'><o:p> </o:p></span></p>
<p class=MsoNormal><span style='color:#1F497D'>This is the way it’s been
done in the past; it should be remembered that building codes are the purview of
the states not the federal government.. Actually, the 1997 NEHRP provisions were
novel in that they came from the Federal government and were handed down to the
states. If any resistance was meet FEMA simply threatens to withdraw funds
for disaster response; at least that’s what happened in Tennessee. <o:p></o:p></span></p>
<p class=MsoNormal><span style='color:#1F497D'><o:p> </o:p></span></p>
<p class=MsoNormal><span style='color:#1F497D'>A top down formulation of
building codes costs private (non-government) building owners to the benefit of
the government. Determining issues beyond life safety and collapse protection,
such as limiting economic loss and having event resistant functionality, is the
right of the building owner, (from my vantage point there is no negotiation on
the limits of these rights).<o:p></o:p></span></p>
<p class=MsoNormal><span style='color:#1F497D'><o:p> </o:p></span></p>
<p class=MsoNormal><span style='color:#1F497D'>In addition the top down
approach makes for some strange politics. As an example, FEMA, the prime agency
funding for the National Earthquake Hazard Reduction Program (NEHRP), in 2003,
insisted that Tennessee pass stringent seismic requirements using the carrot
and stick approach. At one time, citing large economic losses in California
related to earthquakes, FEMA’s Mitigation Director Mr. A. Todd Davison strongly
recommended that the Tennessee Department of Commerce & Insurance pass a
stringent seismic regulations. He went on to say that the consequences for
failing this was the withdrawal of funding for emergency response for
such things as the tornados experienced in Jackson Tennessee in 2003. At the
same time he offered no cost/benefit relationship for the region to justify the
stringent requirements; that is except to cite the billions of dollars lost as
a result of Northridge. He suggested that not passing stringent seismic
requirements would result Federal agencies being “forced to reevaluate
the availability of Federal programs within applicable portions of the
State.” In effect, the adoption of stringent mitigation means that
the cost would be borne by the consumer and taxpayer while the grants and
funding would be sent to the state. The state eventually adopted strong seismic
provisions. Partly because Memphis never had a single fatality, injury, or a
single building collapse as a result of an earthquake, the requirements were
modified opting for a more moderate seismic hazard approach; that is until FEMA
could produce a cost benefit study that would show a net advantage its
citizens. </span><span style='font-size:12.0pt;color:#1F497D'><o:p></o:p></span></p>
<p class=MsoNormal><span style='color:#1F497D'><o:p> </o:p></span></p>
<p class=MsoNormal><span style='color:#1F497D'><o:p> </o:p></span></p>
<div>
<p class=MsoNormal><b><span style='font-size:12.0pt;font-family:"Arial","sans-serif";
color:#1F497D'>Joseph Tomasello, PE</span></b><span style='font-size:12.0pt;
color:#1F497D'><o:p></o:p></span></p>
<p class=MsoNormal><b><span style='font-size:12.0pt;font-family:"Arial","sans-serif";
color:#1F497D'>5880 Ridge Bend Rd.</span></b><span style='font-size:12.0pt;
color:#1F497D'><o:p></o:p></span></p>
<p class=MsoNormal><b><span style='font-size:12.0pt;font-family:"Arial","sans-serif";
color:#1F497D'>Memphis, TN 38120</span></b><span style='font-size:12.0pt;
color:#1F497D'><o:p></o:p></span></p>
<p class=MsoNormal><span style='font-size:12.0pt;color:#1F497D'> <o:p></o:p></span></p>
<p class=MsoNormal><b><i><span style='font-size:12.0pt;font-family:"Arial","sans-serif";
color:#1F497D'>Phone:</span></i></b><i><span style='font-size:12.0pt;
color:#1F497D'><o:p></o:p></span></i></p>
<p class=MsoNormal><b><i><span style='font-size:12.0pt;font-family:"Arial","sans-serif";
color:#1F497D'>(901) 761-2016 office</span></i></b><i><span style='font-size:
12.0pt;color:#1F497D'><o:p></o:p></span></i></p>
<p class=MsoNormal><b><i><span style='font-size:12.0pt;font-family:"Arial","sans-serif";
color:#1F497D'>(901) 821-4968 direct</span></i></b><i><span style='font-size:
12.0pt;color:#1F497D'><o:p></o:p></span></i></p>
</div>
<p class=MsoNormal><b><i><span style='font-size:12.0pt;font-family:"Arial","sans-serif";
color:#1F497D'>(901) 412-8217 mobile</span></i></b><i><span style='color:#1F497D'><o:p></o:p></span></i></p>
<div>
<div style='border:none;border-top:solid #B5C4DF 1.0pt;padding:3.0pt 0in 0in 0in'>
<p class=MsoNormal style='margin-left:.5in'><b><span style='font-size:10.0pt;
font-family:"Tahoma","sans-serif"'>From:</span></b><span style='font-size:10.0pt;
font-family:"Tahoma","sans-serif"'> Wang, Zhenming [mailto:zmwang@email.uky.edu]
<br>
<b>Sent:</b> Friday, January 11, 2008 7:09 AM<br>
<b>To:</b> Rogers, David; Joe Tomasello;
ceus-earthquake-hazards@geohazards.cr.usgs.gov<br>
<b>Cc:</b> Seth Stein<br>
<b>Subject:</b> RE: Re: [CEUS-earthquake-hazards] The balance<o:p></o:p></span></p>
</div>
</div>
<p class=MsoNormal style='margin-left:.5in'><o:p> </o:p></p>
<p class=MsoNormal style='margin-left:.5in'><span style='font-size:10.0pt;
font-family:"Arial","sans-serif";color:navy'>I agree with David that any
mitigation policy should be debated openly. But so far, many of the policies
made for seismic hazard mitigation are not based on scientific facts and open
discussions. The society makes mitigation policies based on risk, not hazard
information. It would be helpful for making sound seismic hazard
mitigation policies if geo-scientists and engineers can define and discuss the
true seismic hazard and risk in the central US.<o:p></o:p></span></p>
<p class=MsoNormal style='margin-left:.5in'><span style='font-size:10.0pt;
font-family:"Arial","sans-serif";color:navy'><o:p> </o:p></span></p>
<p class=MsoNormal style='margin-left:.5in'><span style='font-size:10.0pt;
font-family:"Arial","sans-serif";color:navy'>Zhenming<o:p></o:p></span></p>
<p class=MsoNormal style='margin-left:.5in'><span style='font-size:10.0pt;
font-family:"Arial","sans-serif";color:navy'><o:p> </o:p></span></p>
<div>
<div class=MsoNormal align=center style='margin-left:.5in;text-align:center'><span
style='font-size:12.0pt'>
<hr size=2 width="100%" align=center>
</span></div>
<p class=MsoNormal style='margin-left:.5in'><b><span style='font-size:10.0pt;
font-family:"Tahoma","sans-serif"'>From:</span></b><span style='font-size:10.0pt;
font-family:"Tahoma","sans-serif"'>
ceus-earthquake-hazards-bounces@geohazards.cr.usgs.gov
[mailto:ceus-earthquake-hazards-bounces@geohazards.cr.usgs.gov] <b>On Behalf Of
</b>Rogers, David<br>
<b>Sent:</b> Wednesday, January 09, 2008 6:01 PM<br>
<b>To:</b> Joe Tomasello; ceus-earthquake-hazards@geohazards.cr.usgs.gov<br>
<b>Cc:</b> Seth Stein<br>
<b>Subject:</b> Re: [CEUS-earthquake-hazards] The balance</span><span
style='font-size:12.0pt'><o:p></o:p></span></p>
</div>
<p class=MsoNormal style='margin-left:.5in'><o:p> </o:p></p>
<p class=MsoNormal style='margin-left:.5in'><span style='font-size:10.0pt;
font-family:"Arial","sans-serif";color:navy'>Joe <o:p></o:p></span></p>
<p class=MsoNormal style='margin-left:.5in'><span style='font-size:10.0pt;
font-family:"Arial","sans-serif";color:navy'><o:p> </o:p></span></p>
<p class=MsoNormal style='margin-left:.5in'><span style='font-size:10.0pt;
font-family:"Arial","sans-serif";color:navy'>This isn’t a new issue; the
CA Seismic Safety Commission has had to deal with these kinds of issues for
years. The figure I’d be suspicious of is the $110 billion being
suggested by the California Healthcare Association, which is a trade
organization that lobbies for favorable legislation on behalf of hospital
owners and operators – many of which are wealthy corporations. They
consistently oppose legislation that mandates increased government regulations
or costs. They are the same organization that fought against hospitals being
required to have their own onsite power generation back in the early 1960s,
asserting that it would be cost-prohibitive and never be utilized sufficiently
to justify the costs, etc. etc. And they had numbers that
“proved” their case, because CA hadn’t experienced a sizable
earthquake near a metropolitan area between 1906-71 (the utilization
calculation would be very different today, esp. with the summertime power
brownouts). These sorts of organizations and lobbyists always throw out
huge dollar values to justify their cases – e.g. if you put that
regulation on us, it will put us out of business and it will costs billions and
billions of dollars, etc. etc. There will be a cost, but what that
actual cost will end up being is usually inflated significantly by trade
organizations when they are opposing proposed legislation. That’s
just the way the lobbying game is played.<o:p></o:p></span></p>
<p class=MsoNormal style='margin-left:.5in'><span style='font-size:10.0pt;
font-family:"Arial","sans-serif";color:navy'><o:p> </o:p></span></p>
<p class=MsoNormal style='margin-left:.5in'><span style='font-size:10.0pt;
font-family:"Arial","sans-serif";color:navy'>We’ve dealt with a similar,
but smaller issues here in Missouri, whenever legislation is proposed (almost
every year) to require skilled care and convalescent facilities to furnish
onsite remote power generation -- they spend huge amounts of money to
repress such legislation, asserting that it will “bankrupt” them
and that their facilities are “barely scrapping by” because their
patient fees are controlled by Medicare, etc., etc., etc. That’s
what the SAY anyway ….. but, when you see the slick lawyers doing their
lobbying, you sort of get the felling that SOMEBODY is making enough money in
the skilled care facility business to hire high-powered lobbyists….
<o:p></o:p></span></p>
<p class=MsoNormal style='margin-left:.5in'><span style='font-size:10.0pt;
font-family:"Arial","sans-serif";color:navy'><o:p> </o:p></span></p>
<p class=MsoNormal style='margin-left:.5in'><span style='font-size:10.0pt;
font-family:"Arial","sans-serif";color:navy'>So, there’s always two sides
to every tale. I would agree that, as engineers or planners, we should
always be examining the cost-benefit ratios. But, we should also realize
that the actual dollar losses incurred by a natural or man-caused disaster are
far beyond the figures predicted in FEMA models like HAZUS. Just look at the economic
impact of the 9/11 attacks; the two World Trade Center towers are only a tiny
fraction of the actual economic loss caused by their collapse. <o:p></o:p></span></p>
<p class=MsoNormal style='margin-left:.5in'><span style='font-size:10.0pt;
font-family:"Arial","sans-serif";color:navy'><o:p> </o:p></span></p>
<p class=MsoNormal style='margin-left:.5in'><span style='font-size:10.0pt;
font-family:"Arial","sans-serif";color:navy'>So, these issues should be debated
out in the open, realizing that most people come to the table with specific
agendas…..In raising that issue, your concern is valid.
<o:p></o:p></span></p>
<p class=MsoNormal style='margin-left:.5in'><span style='font-size:10.0pt;
font-family:"Arial","sans-serif";color:navy'><o:p> </o:p></span></p>
<p class=MsoNormal style='margin-left:.5in'><span style='font-size:10.0pt;
font-family:"Arial","sans-serif";color:navy'>Dave Rogers<o:p></o:p></span></p>
<p class=MsoNormal style='margin-left:.5in'><span style='font-size:10.0pt;
font-family:"Arial","sans-serif";color:navy'>Missouri Seismic Safety Commission<o:p></o:p></span></p>
<p class=MsoNormal style='margin-left:.5in'><span style='font-size:10.0pt;
font-family:"Arial","sans-serif";color:navy'><o:p> </o:p></span></p>
<div>
<p style='margin-left:.5in'><span style='font-size:10.0pt;color:navy'>J. David
Rogers, Ph.D., P.E., R.G., C.E.G., C.H.G.<br>
Karl F. Hasselmann Chair in Geological Engineering<br>
Department of Geological Engineering<br>
129 McNutt Hall, 1400 N. Bishop Avenue<br>
Missouri University of Science & Technology<br>
Rolla, MO 65409-0230<br>
(573) 341-6198 voice<br>
(573) 341-6935 fax<br>
E-mail: rogersda@mst.edu<br>
URL: www.mst.edu/~rogersda<br>
<br>
Formerly the University of Missouri-Rolla<br>
<br>
</span><span style='color:navy'> </span><o:p></o:p></p>
</div>
<div>
<div class=MsoNormal align=center style='margin-left:.5in;text-align:center'><span
style='font-size:12.0pt'>
<hr size=2 width="100%" align=center>
</span></div>
<p class=MsoNormal style='margin-left:.5in'><b><span style='font-size:10.0pt;
font-family:"Tahoma","sans-serif"'>From:</span></b><span style='font-size:10.0pt;
font-family:"Tahoma","sans-serif"'>
ceus-earthquake-hazards-bounces@geohazards.cr.usgs.gov
[mailto:ceus-earthquake-hazards-bounces@geohazards.cr.usgs.gov] <b>On Behalf Of
</b>Joe Tomasello<br>
<b>Sent:</b> Wednesday, January 09, 2008 1:51 PM<br>
<b>To:</b> ceus-earthquake-hazards@geohazards.cr.usgs.gov<br>
<b>Cc:</b> 'Seth Stein'<br>
<b>Subject:</b> [CEUS-earthquake-hazards] The balance</span><span
style='font-size:12.0pt'><o:p></o:p></span></p>
</div>
<p class=MsoNormal style='margin-left:.5in'><o:p> </o:p></p>
<p class=MsoNormal style='margin-left:.5in'>Buddy:<o:p></o:p></p>
<p class=MsoNormal style='margin-left:.5in'><o:p> </o:p></p>
<p class=MsoNormal style='margin-left:.5in'>I’d like to offer the
following for your e-mail discussion group:<o:p></o:p></p>
<p class=MsoNormal style='margin-left:.5in'><o:p> </o:p></p>
<p class=MsoNormal style='margin-left:.5in'><o:p> </o:p></p>
<p class=MsoNormal style='margin-left:.5in'>Natural disasters such as
earthquakes create complex situations for policy makers. The difficulty lies in
the balance between the costs of mitigation and the actual risk. Failing this,
policy makers could find themselves dealing with unintended consequences such
as those experienced by the hospital industry in California. If
it’s worth the expense in any one region it would be California; but
looking at the hospital industry in California we don’t see it.<o:p></o:p></p>
<p class=MsoNormal style='margin-left:.5in'><o:p> </o:p></p>
<p class=MsoNormal style='margin-left:.5in'>Earthquake risks in California are,
to some degree, statistically predictable; being a near certainty that a
moderate to strong earthquake will occur somewhere on the west coast during a
single generation of the built environment. California attempted to balance
public safety with mandated seismic mitigation in a knee jerk reaction to the
1994 Northridge earthquake California’s Legislature passed Senate Bill
1953 (SB 1953). The bill was an unfunded mandate to retrofit, rebuild, or
close; a free lunch for California taxpayer. However, over the past decade the
consequences of the mandate caused a once sound hospital system transform into
one of the nation’s foremost financial basket cases.<o:p></o:p></p>
<p class=MsoNormal style='margin-left:.5in'><o:p> </o:p></p>
<p class=MsoNormal style='margin-left:.5in'>As in California, policy makers in
the New Madrid Seismic Zone are led to believe that earthquake mitigation costs
are small, having little effect on the built environment. California’s mitigation
program entails retrofitting all acute care hospitals or re-building nearly 70
million square feet. The pace of construction is limited to approximately 1.5
million to 2 million square feet per year due in large part to the ability of
regulatory agencies to keep up. Furthermore it takes upward of 10 years to
design and build a new hospital. “The lengthy process for review
and approval of hospital construction and retrofitting projects is far too
long. Economic growth is being thwarted; jobs are being lost; and patient
safety is being compromised.”<a style='mso-endnote-id:edn1' href="#_edn1"
name="_ednref1" title=""><span class=MsoEndnoteReference>[i]</span></a>
The result is that it will take nearly 30 years to complete all the
construction required by SB 1953. <a style='mso-endnote-id:edn2' href="#_edn2"
name="_ednref2" title=""><span class=MsoEndnoteReference>[ii]</span></a> The
extended deadline is 2013.<o:p></o:p></p>
<p class=MsoNormal style='margin-left:.5in'><o:p> </o:p></p>
<p class=MsoNormal style='margin-left:.5in'>The size and scope of most of these
projects are very large and expensive. Compliance could cost California
hospitals as much as $110 billion dollars. The original estimate assumed
that the number of patients and the number of beds would generally remain the
same. However, modern design standards are most effective with facilities
35% to 60% larger<a style='mso-endnote-id:edn3' href="#_edn3" name="_ednref3"
title=""><span class=MsoEndnoteReference>[iii]</span></a>. Thus, the scope of
each construction project will increase as will the overall cost; perhaps as
much as 20%. <a style='mso-endnote-id:edn4' href="#_edn4" name="_ednref4"
title=""><span class=MsoEndnoteReference>[iv]</span></a> In California
construction costs are rising at an annual rate of more than 14 percent above
the Consumer Price Index resulting in construction costs more than 40 percent
higher for comparable facilities in other states.<a style='mso-endnote-id:edn5'
href="#_edn5" name="_ednref5" title=""><span class=MsoEndnoteReference>[v]</span></a>
In my view this increase is likely to continue do to regulatory oversight, the
limited number of qualified contractors, as well as the annual inflation of
material costs. In California, a fully furnished and equipped acute care
facility (labor and materials) costs $1,000 per square foot. Since the SB
1953 mandates affect for-profit, non-profit and publicly owned organizations
most all projects will be financed. Depending on the terms of the loan
the cost in current dollars for an acute care facility the square foot cost can
exceed $2,800; comparatively normal office construction in Tennessee is roughly
a third the cost per square foot.<span style='font-size:12.0pt'> <o:p></o:p></span></p>
<p class=MsoNormal style='margin-left:.5in'><o:p> </o:p></p>
<p class=MsoNormal style='margin-left:.5in'>Looking at FEMA’s annualized
earthquake losses<a style='mso-endnote-id:edn6' href="#_edn6" name="_ednref6"
title=""><span class=MsoEndnoteReference>[vi]</span></a> we find the
relationship of Cost vs. Benefit even more lopsided. FEMA reports that
California will experience a loss of approximately $3,167.5/$Million of
infrastructure each year as a result of earthquakes. Looking at the same 50
year period, California can expect to lose approximately 15.8% of the present
value of hospitals. Thus, California’s acute care infrastructure, worth approximately
$48 Billion [my estimate - C. Duane Dauner, President and Chief Executive
Officer, California Healthcare Association, Statement “Heath Care Scene
in California,” May 10, 2001, suggested 24 Billion.], should expect a
loss of approximately $7.6 Billion due to earthquake. We find that California
is spending $110 Billion to offset a loss of $7.6 Billion; a cost benefit
relationship greater than 14. <span style='font-size:12.0pt'>Over the
past 10 years, we’ve asked FEMA for a </span>Cost vs. Benefit analysis
for the New Madrid Seismic Zone. So far we haven’t seen anything
that would come close to suggesting that the public would benefit spending
limited resources. <span style='font-size:12.0pt'><o:p></o:p></span></p>
<p class=MsoNormal style='margin-left:.5in'><span style='font-size:12.0pt'><o:p> </o:p></span></p>
<p class=MsoNormal style='margin-left:.5in'>There are a more subtle negative
consequences resulting from forcing acute care facilities to close because they
don’t meet mandated requirements. California is experiencing a
critical closure of hospitals with the closure of over 50 hospitals in the 10
year period between 1995 and 2005. More than 3,000 acute care beds have been
removed from service between 2001 and 2005. In the five year period prior (1995
to 1999) 23 hospitals closed. Unfunded mandated seismic requirements are
creating a stampede for funding, usually in the form of bonds. The median
credit ratio of California hospitals had nosed dived to the junk-bond status.
The money needed to retro fit California hospitals is drying up. <a
style='mso-endnote-id:edn7' href="#_edn7" name="_ednref7" title=""><span
class=MsoEndnoteReference>[vii]</span></a> “Nobody can bear the burden
[of SB 1953 unfunded mandate]”<a style='mso-endnote-id:edn8' href="#_edn8"
name="_ednref8" title=""><span class=MsoEndnoteReference>[viii]</span></a>
Here in the New Madrid Seismic Zone we’re told that the cost is
minimal. <o:p></o:p></p>
<p class=MsoNormal style='margin-left:.5in'><o:p> </o:p></p>
<p class=MsoNormal style='margin-left:.5in'>“Seismic upgrades are
important. But mandating them during the worst economic time in the history of
California hospitals is like ordering a homeowner to fix a dilapidated porch on
a house that's on fire. Right idea. Wrong time.”<a style='mso-endnote-id:
edn9' href="#_edn9" name="_ednref9" title=""><span class=MsoEndnoteReference>[ix]</span></a>
How many doctors and nurses could have been hired in lieu of spending the money
on hospital infrastructure? Just how many lives will be saved? How many lives
will be lost because of the loss of acute care facilities? Who pays, the
bottomless pocket of the taxpayer? Each of the 35 million people in California
will need to pay $3,143 (per capita state and local taxes were roughly $1,600
in 1996). Are the people of California going to be willing to forfeit
three times their current tax burden? <o:p></o:p></p>
<p class=MsoNormal style='margin-left:.5in'><o:p> </o:p></p>
<p class=MsoNormal style='margin-left:.5in'>If the benefits (reduction of
earthquake related economic loss or lives lost) don’t outweigh the costs
in California, how can they be justified in the New Madrid Seismic Zone? <o:p></o:p></p>
<p class=MsoNormal style='margin-left:.5in'><o:p> </o:p></p>
<p class=MsoNormal style='margin-left:.5in'><o:p> </o:p></p>
<p class=MsoNormal style='margin-left:.5in'><b><span style='font-size:12.0pt;
font-family:"Arial","sans-serif"'>Joseph Tomasello, PE</span></b><span
style='font-size:12.0pt'><o:p></o:p></span></p>
<p class=MsoNormal style='margin-left:.5in'><b><span style='font-size:12.0pt;
font-family:"Arial","sans-serif"'>5880 Ridge Bend Rd.</span></b><span
style='font-size:12.0pt'><o:p></o:p></span></p>
<p class=MsoNormal style='margin-left:.5in'><b><span style='font-size:12.0pt;
font-family:"Arial","sans-serif"'>Memphis, TN 38120</span></b><span
style='font-size:12.0pt'><o:p></o:p></span></p>
<p class=MsoNormal style='margin-left:.5in'><span style='font-size:12.0pt'> <o:p></o:p></span></p>
<p class=MsoNormal style='margin-left:.5in'><b><span style='font-size:12.0pt;
font-family:"Arial","sans-serif"'>Phone:</span></b><span style='font-size:12.0pt'><o:p></o:p></span></p>
<p class=MsoNormal style='margin-left:.5in'><b><span style='font-size:12.0pt;
font-family:"Arial","sans-serif"'>(901) 761-2016 office</span></b><span
style='font-size:12.0pt'><o:p></o:p></span></p>
<p class=MsoNormal style='margin-left:.5in'><b><span style='font-size:12.0pt;
font-family:"Arial","sans-serif"'>(901) 821-4968 direct</span></b><span
style='font-size:12.0pt'><o:p></o:p></span></p>
<p class=MsoNormal style='margin-left:.5in'><b><span style='font-size:12.0pt;
font-family:"Arial","sans-serif"'>(901) 412-8217 mobile</span></b><o:p></o:p></p>
<div>
<p class=MsoNormal style='margin-left:.5in'><span style='font-size:12.0pt'><br
clear=all>
<o:p></o:p></span></p>
<div>
<div>
<div>
<div>
<div class=MsoNormal style='margin-left:.5in'><span style='font-size:12.0pt'>
<hr size=1 width="33%" align=left>
</span></div>
</div>
</div>
</div>
</div>
</div>
<div>
<p class=MsoNormal style='margin-left:.5in'><span style='font-size:12.0pt'><br
clear=all>
<o:p></o:p></span></p>
<div>
<div>
<div>
<div class=MsoNormal style='margin-left:.5in'><span style='font-size:12.0pt'>
<hr size=1 width="33%" align=left>
</span></div>
</div>
</div>
</div>
</div>
<div>
<p class=MsoNormal style='margin-left:.5in'><span style='font-size:12.0pt'><br
clear=all>
<o:p></o:p></span></p>
<div>
<div>
<div class=MsoNormal style='margin-left:.5in'><span style='font-size:12.0pt'>
<hr size=1 width="33%" align=left>
</span></div>
</div>
</div>
</div>
<div>
<p class=MsoNormal style='margin-left:.5in'><span style='font-size:12.0pt'><br
clear=all>
<o:p></o:p></span></p>
<div>
<div class=MsoNormal style='margin-left:.5in'><span style='font-size:12.0pt'>
<hr size=1 width="33%" align=left>
</span></div>
</div>
</div>
<div>
<p class=MsoNormal style='margin-left:.5in'><span style='font-size:12.0pt'><br
clear=all>
<o:p></o:p></span></p>
<div class=MsoNormal style='margin-left:.5in'><span style='font-size:12.0pt'>
<hr size=1 width="33%" align=left>
</span></div>
</div>
</div>
<div style='mso-element:endnote-list'><br clear=all>
<hr align=left size=1 width="33%">
<div style='mso-element:endnote' id=edn1>
<p class=MsoEndnoteText><a style='mso-endnote-id:edn1' href="#_ednref1"
name="_edn1" title=""><span class=MsoEndnoteReference>[i]</span></a> California
Heathcare Association Statement on the Hospital Construction Plan Review and
Area Compliance Process before the California Performance Review Commission,
U.C. Riverside, August 13, 2004.<o:p></o:p></p>
</div>
<div style='mso-element:endnote' id=edn2>
<p class=MsoEndnoteText><a style='mso-endnote-id:edn2' href="#_ednref2"
name="_edn2" title=""><span class=MsoEndnoteReference>[ii]</span></a> Ibid., 4<o:p></o:p></p>
</div>
<div style='mso-element:endnote' id=edn3>
<p class=MsoEndnoteText><a style='mso-endnote-id:edn3' href="#_ednref3"
name="_edn3" title=""><span class=MsoEndnoteReference>[iii]</span></a> Ibid.,
41<o:p></o:p></p>
</div>
<div style='mso-element:endnote' id=edn4>
<p class=MsoEndnoteText><a style='mso-endnote-id:edn4' href="#_ednref4"
name="_edn4" title=""><span class=MsoEndnoteReference>[iv]</span></a> Ibid., 8<o:p></o:p></p>
</div>
<div style='mso-element:endnote' id=edn5>
<p class=MsoEndnoteText><a style='mso-endnote-id:edn5' href="#_ednref5"
name="_edn5" title=""><span class=MsoEndnoteReference>[v]</span></a> Ibid., 30<o:p></o:p></p>
</div>
<div style='mso-element:endnote' id=edn6>
<p class=MsoEndnoteText><a style='mso-endnote-id:edn6' href="#_ednref6"
name="_edn6" title=""><span class=MsoEndnoteReference>[vi]</span></a>
FEMA 366 Hazus 99 Estimated Annualized Earthquake Losses for the United
States, February 2001, 16<o:p></o:p></p>
</div>
<div style='mso-element:endnote' id=edn7>
<p class=MsoEndnoteText><a style='mso-endnote-id:edn7' href="#_ednref7"
name="_edn7" title=""><span class=MsoEndnoteReference>[vii]</span></a>
California HealthCare Foundation, The Financial Health of California Hospitals,
June 2007, 2-13<o:p></o:p></p>
</div>
<div style='mso-element:endnote' id=edn8>
<p class=MsoEndnoteText><a style='mso-endnote-id:edn8' href="#_ednref8"
name="_edn8" title=""><span class=MsoEndnoteReference>[viii]</span></a> Ibid.,
(interviews with key unnamed health care leaders), B-6<o:p></o:p></p>
</div>
<div style='mso-element:endnote' id=edn9>
<p class=MsoEndnoteText><a style='mso-endnote-id:edn9' href="#_ednref9"
name="_edn9" title=""><span class=MsoEndnoteReference>[ix]</span></a> The Press
Democrat, Another hospital falls, what killed Sutter Medical Center – and
what will it mean to families like mine, January 14, 2007<o:p></o:p></p>
</div>
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