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<p class=MsoNormal><font size=2 color=navy face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:navy'>To All:</span></font></p>
<p class=MsoNormal><font size=2 color=navy face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:navy'> </span></font></p>
<p class=MsoNormal><font size=2 color=navy face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:navy'>speaking purely for myself and NOT the Red
Cross, I see several different issues being discussed here.</span></font></p>
<p class=MsoNormal><font size=2 color=navy face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:navy'>As a Red Cross NHQ employee, and as a
structural engineer, I am interested in all of these issues.</span></font></p>
<p class=MsoNormal><font size=2 color=navy face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:navy'> </span></font></p>
<p class=MsoNormal><font size=2 color=navy face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:navy'>One issue is what present science says
about the known hazards from earthquakes in the central US. As everyone who
follows this topic knows, we are learning more all the time, but there is still
much to be learned about this.</span></font></p>
<p class=MsoNormal><font size=2 color=navy face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:navy'> </span></font></p>
<p class=MsoNormal><font size=2 color=navy face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:navy'>Another issue is what public policy, if
any, should be promulgated by the United States government given the
present state of knowledge.</span></font></p>
<p class=MsoNormal><font size=2 color=navy face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:navy'><br>
Still another topic is what the present seismic risks to various elements of
the local economy, local infrastructure and national economy are assessed to be
in the central US.</span></font></p>
<p class=MsoNormal><font size=2 color=navy face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:navy'><br>
Yet another issue is what, if anything, States and local government entities
should be doing WRT regulation of the building design process, and what level
of Federal compulsion is appropriate, if any.</span></font></p>
<p class=MsoNormal><font size=2 color=navy face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:navy'> </span></font></p>
<p class=MsoNormal><font size=2 color=navy face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:navy'>Engineering cost-benefit analysis is a
tool that can be applied to assist in the evaluation of all of these issues,
but it is NOT the only tool, nor is it perfect.</span></font></p>
<p class=MsoNormal><font size=2 color=navy face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:navy'> </span></font></p>
<p class=MsoNormal><font size=2 color=navy face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:navy'>I would like, with the utmost respect to
all, to suggest that I, as an end user of the information being discussed,
would benefit from having each of the above topics discussed objectively, <b><span
style='font-weight:bold'>separately</span></b> and dispassionately. I
think it is fair to say that there is legitimate grounds for debate on
significant portions of all of the above issues, and the fact that there is
disagreement on these issues is not necessarily any reflection on the ability
or good will of any of the debaters. I’d like to see the discussion
continue on each of the issues above.</span></font></p>
<p class=MsoNormal><font size=2 color=navy face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:navy'> </span></font></p>
<p class=MsoNormal><font size=2 color=navy face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:navy'>I would also say that while it is
difficult for engineers to justify structural requirements in excess of those
required by code to a building owner, it can be done, witness the design
requirements for the new Red Cross blood center in the St Louis area, which
significantly exceed those required by local code. That cost-benefit analysis
showed clearly that the Red Cross would benefit by such a decision, which was
why we elected that course of action independent of the local code requirements.</span></font></p>
<p class=MsoNormal><font size=2 color=navy face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:navy'> </span></font></p>
<div>
<p class=MsoAutoSig><font size=3 color=navy face="Times New Roman"><span
style='font-size:12.0pt;color:navy'>Laurence M. Wright</span></font></p>
<p class=MsoAutoSig><font size=3 color=navy face="Times New Roman"><span
style='font-size:12.0pt;color:navy'>Senior Project Engineer</span></font></p>
<p class=MsoAutoSig><font size=3 color=navy face="Times New Roman"><span
style='font-size:12.0pt;color:navy'>Red Cross Manufacturing Engineering</span></font></p>
<p class=MsoAutoSig><font size=3 color=navy face="Times New Roman"><span
style='font-size:12.0pt;color:navy'>202-303-4457 (o)</span></font></p>
<p class=MsoAutoSig><font size=3 color=navy face="Times New Roman"><span
style='font-size:12.0pt;color:navy'>202-549-5843 (c)</span></font></p>
</div>
<p class=MsoNormal><font size=2 color=navy face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:navy'> </span></font></p>
<div style='border:none;border-left:solid blue 1.5pt;padding:0in 0in 0in 4.0pt'>
<p class=MsoNormal><font size=2 face=Tahoma><span style='font-size:10.0pt;
font-family:Tahoma'>-----Original Message-----<br>
<b><span style='font-weight:bold'>From:</span></b> ceus-earthquake-hazards-bounces@geohazards.cr.usgs.gov
[mailto:ceus-earthquake-hazards-bounces@geohazards.cr.usgs.gov] <b><span
style='font-weight:bold'>On Behalf Of </span></b>Wang, Zhenming<br>
<b><span style='font-weight:bold'>Sent:</span></b> Friday, January 11, 2008
8:09 AM<br>
<b><span style='font-weight:bold'>To:</span></b> Rogers, David; Joe Tomasello; ceus-earthquake-hazards@geohazards.cr.usgs.gov<br>
<b><span style='font-weight:bold'>Cc:</span></b> Seth Stein<br>
<b><span style='font-weight:bold'>Subject:</span></b> Re: [CEUS-earthquake-hazards]
The balance</span></font></p>
<p class=MsoNormal><font size=2 face="Times New Roman"><span style='font-size:
11.0pt'> </span></font></p>
<p class=MsoNormal><font size=2 color=navy face=Arial><span style='font-size:
10.0pt;font-family:Arial;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.</span></font></p>
<p class=MsoNormal><font size=2 color=navy face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:navy'> </span></font></p>
<p class=MsoNormal><font size=2 color=navy face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:navy'>Zhenming</span></font></p>
<p class=MsoNormal><font size=2 color=navy face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:navy'> </span></font></p>
<div>
<div class=MsoNormal align=center style='text-align:center'><font size=3
face="Times New Roman"><span style='font-size:12.0pt'>
<hr size=2 width="100%" align=center>
</span></font></div>
<p class=MsoNormal><b><font size=2 face=Tahoma><span style='font-size:10.0pt;
font-family:Tahoma;font-weight:bold'>From:</span></font></b><font size=2
face=Tahoma><span style='font-size:10.0pt;font-family:Tahoma'> ceus-earthquake-hazards-bounces@geohazards.cr.usgs.gov
[mailto:ceus-earthquake-hazards-bounces@geohazards.cr.usgs.gov] <b><span
style='font-weight:bold'>On Behalf Of </span></b>Rogers, David<br>
<b><span style='font-weight:bold'>Sent:</span></b> Wednesday, January 09, 2008
6:01 PM<br>
<b><span style='font-weight:bold'>To:</span></b> Joe Tomasello; ceus-earthquake-hazards@geohazards.cr.usgs.gov<br>
<b><span style='font-weight:bold'>Cc:</span></b> Seth Stein<br>
<b><span style='font-weight:bold'>Subject:</span></b> Re: [CEUS-earthquake-hazards]
The balance</span></font></p>
</div>
<p class=MsoNormal><font size=2 face="Times New Roman"><span style='font-size:
11.0pt'> </span></font></p>
<p class=MsoNormal><font size=2 color=navy face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:navy'>Joe </span></font></p>
<p class=MsoNormal><font size=2 color=navy face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:navy'> </span></font></p>
<p class=MsoNormal><font size=2 color=navy face=Arial><span style='font-size:
10.0pt;font-family:Arial;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.</span></font></p>
<p class=MsoNormal><font size=2 color=navy face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:navy'> </span></font></p>
<p class=MsoNormal><font size=2 color=navy face=Arial><span style='font-size:
10.0pt;font-family:Arial;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….
</span></font></p>
<p class=MsoNormal><font size=2 color=navy face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:navy'> </span></font></p>
<p class=MsoNormal><font size=2 color=navy face=Arial><span style='font-size:
10.0pt;font-family:Arial;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. </span></font></p>
<p class=MsoNormal><font size=2 color=navy face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:navy'> </span></font></p>
<p class=MsoNormal><font size=2 color=navy face=Arial><span style='font-size:
10.0pt;font-family:Arial;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.
</span></font></p>
<p class=MsoNormal><font size=2 color=navy face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:navy'> </span></font></p>
<p class=MsoNormal><font size=2 color=navy face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:navy'>Dave Rogers</span></font></p>
<p class=MsoNormal><font size=2 color=navy face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:navy'>Missouri Seismic Safety Commission</span></font></p>
<p class=MsoNormal><font size=2 color=navy face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:navy'> </span></font></p>
<div>
<p><font size=2 color=navy face="Times New Roman"><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></font><font color=navy><span style='color:navy'> </span></font></p>
</div>
<div>
<div class=MsoNormal align=center style='text-align:center'><font size=3
face="Times New Roman"><span style='font-size:12.0pt'>
<hr size=2 width="100%" align=center>
</span></font></div>
<p class=MsoNormal><b><font size=2 face=Tahoma><span style='font-size:10.0pt;
font-family:Tahoma;font-weight:bold'>From:</span></font></b><font size=2
face=Tahoma><span style='font-size:10.0pt;font-family:Tahoma'> ceus-earthquake-hazards-bounces@geohazards.cr.usgs.gov
[mailto:ceus-earthquake-hazards-bounces@geohazards.cr.usgs.gov] <b><span
style='font-weight:bold'>On Behalf Of </span></b>Joe Tomasello<br>
<b><span style='font-weight:bold'>Sent:</span></b> Wednesday, January 09, 2008
1:51 PM<br>
<b><span style='font-weight:bold'>To:</span></b> ceus-earthquake-hazards@geohazards.cr.usgs.gov<br>
<b><span style='font-weight:bold'>Cc:</span></b> 'Seth Stein'<br>
<b><span style='font-weight:bold'>Subject:</span></b> [CEUS-earthquake-hazards]
The balance</span></font></p>
</div>
<p class=MsoNormal><font size=2 face="Times New Roman"><span style='font-size:
11.0pt'> </span></font></p>
<p class=MsoNormal><font size=2 face="Times New Roman"><span style='font-size:
11.0pt'>Buddy:</span></font></p>
<p class=MsoNormal><font size=2 face="Times New Roman"><span style='font-size:
11.0pt'> </span></font></p>
<p class=MsoNormal><font size=2 face="Times New Roman"><span style='font-size:
11.0pt'>I’d like to offer the following for your e-mail discussion group:</span></font></p>
<p class=MsoNormal><font size=2 face="Times New Roman"><span style='font-size:
11.0pt'> </span></font></p>
<p class=MsoNormal><font size=2 face="Times New Roman"><span style='font-size:
11.0pt'> </span></font></p>
<p class=MsoNormal><font size=2 face="Times New Roman"><span style='font-size:
11.0pt'>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.</span></font></p>
<p class=MsoNormal><font size=2 face="Times New Roman"><span style='font-size:
11.0pt'> </span></font></p>
<p class=MsoNormal><font size=2 face="Times New Roman"><span style='font-size:
11.0pt'>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.</span></font></p>
<p class=MsoNormal><font size=2 face="Times New Roman"><span style='font-size:
11.0pt'> </span></font></p>
<p class=MsoNormal><font size=2 face="Times New Roman"><span style='font-size:
11.0pt'>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 href="#_edn1" name="_ednref1" title=""><span
class=MsoEndnoteReference><sup>[i]</sup></span></a> The result is that it
will take nearly 30 years to complete all the construction required by SB 1953.
<a href="#_edn2" name="_ednref2" title=""><span class=MsoEndnoteReference><sup>[ii]</sup></span></a>
The extended deadline is 2013.</span></font></p>
<p class=MsoNormal><font size=2 face="Times New Roman"><span style='font-size:
11.0pt'> </span></font></p>
<p class=MsoNormal><font size=2 face="Times New Roman"><span style='font-size:
11.0pt'>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
href="#_edn3" name="_ednref3" title=""><span class=MsoEndnoteReference><sup>[iii]</sup></span></a>.
Thus, the scope of each construction project will increase as will the overall
cost; perhaps as much as 20%. <a href="#_edn4" name="_ednref4" title=""><span
class=MsoEndnoteReference><sup>[iv]</sup></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 href="#_edn5" name="_ednref5" title=""><span
class=MsoEndnoteReference><sup>[v]</sup></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></font><font size=3><span style='font-size:12.0pt'>
</span></font></p>
<p class=MsoNormal><font size=2 face="Times New Roman"><span style='font-size:
11.0pt'> </span></font></p>
<p class=MsoNormal><font size=2 face="Times New Roman"><span style='font-size:
11.0pt'>Looking at FEMA’s annualized earthquake losses<a href="#_edn6"
name="_ednref6" title=""><span class=MsoEndnoteReference><sup>[vi]</sup></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></font><font size=3><span
style='font-size:12.0pt'>Over the past 10 years, we’ve asked FEMA for a </span></font>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. </p>
<p class=MsoNormal><font size=3 face="Times New Roman"><span style='font-size:
12.0pt'> </span></font></p>
<p class=MsoNormal><font size=2 face="Times New Roman"><span style='font-size:
11.0pt'>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 href="#_edn7"
name="_ednref7" title=""><span class=MsoEndnoteReference><sup>[vii]</sup></span></a>
“Nobody can bear the burden [of SB 1953 unfunded mandate]”<a
href="#_edn8" name="_ednref8" title=""><span class=MsoEndnoteReference><sup>[viii]</sup></span></a>
Here in the New Madrid Seismic Zone we’re told that the cost is
minimal. </span></font></p>
<p class=MsoNormal><font size=2 face="Times New Roman"><span style='font-size:
11.0pt'> </span></font></p>
<p class=MsoNormal><font size=2 face="Times New Roman"><span style='font-size:
11.0pt'>“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 href="#_edn9" name="_ednref9" title=""><span
class=MsoEndnoteReference><sup>[ix]</sup></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? </span></font></p>
<p class=MsoNormal><font size=2 face="Times New Roman"><span style='font-size:
11.0pt'> </span></font></p>
<p class=MsoNormal><font size=2 face="Times New Roman"><span style='font-size:
11.0pt'>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? </span></font></p>
<p class=MsoNormal><font size=2 face="Times New Roman"><span style='font-size:
11.0pt'> </span></font></p>
<p class=MsoNormal><font size=2 face="Times New Roman"><span style='font-size:
11.0pt'> </span></font></p>
<p class=MsoNormal><b><font size=3 face=Arial><span style='font-size:12.0pt;
font-family:Arial;font-weight:bold'>Joseph Tomasello, PE</span></font></b></p>
<p class=MsoNormal><b><font size=3 face=Arial><span style='font-size:12.0pt;
font-family:Arial;font-weight:bold'>5880 Ridge Bend Rd.</span></font></b></p>
<p class=MsoNormal><b><font size=3 face=Arial><span style='font-size:12.0pt;
font-family:Arial;font-weight:bold'>Memphis, TN </span></font></b><b><font
size=3 face=Arial><span style='font-size:12.0pt;font-family:Arial;font-weight:
bold'>38120</span></font></b></p>
<p class=MsoNormal><font size=3 face="Times New Roman"><span style='font-size:
12.0pt'> </span></font></p>
<p class=MsoNormal><b><font size=3 face=Arial><span style='font-size:12.0pt;
font-family:Arial;font-weight:bold'>Phone:</span></font></b></p>
<p class=MsoNormal><b><font size=3 face=Arial><span style='font-size:12.0pt;
font-family:Arial;font-weight:bold'>(901) 761-2016 office</span></font></b></p>
<p class=MsoNormal><b><font size=3 face=Arial><span style='font-size:12.0pt;
font-family:Arial;font-weight:bold'>(901) 821-4968 direct</span></font></b></p>
<p class=MsoNormal><b><font size=3 face=Arial><span style='font-size:12.0pt;
font-family:Arial;font-weight:bold'>(901) 412-8217 mobile</span></font></b></p>
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<div id=edn1>
<p class=MsoEndnoteText><a href="#_ednref1" name="_edn1" title=""><span
class=MsoEndnoteReference><sup><font size=2 face="Times New Roman"><span
style='font-size:10.0pt'>[i]</span></font></sup></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.</p>
</div>
<div id=edn2>
<p class=MsoEndnoteText><a href="#_ednref2" name="_edn2" title=""><span
class=MsoEndnoteReference><sup><font size=2 face="Times New Roman"><span
style='font-size:10.0pt'>[ii]</span></font></sup></span></a> Ibid., 4</p>
</div>
<div id=edn3>
<p class=MsoEndnoteText><a href="#_ednref3" name="_edn3" title=""><span
class=MsoEndnoteReference><sup><font size=2 face="Times New Roman"><span
style='font-size:10.0pt'>[iii]</span></font></sup></span></a> Ibid., 41</p>
</div>
<div id=edn4>
<p class=MsoEndnoteText><a href="#_ednref4" name="_edn4" title=""><span
class=MsoEndnoteReference><sup><font size=2 face="Times New Roman"><span
style='font-size:10.0pt'>[iv]</span></font></sup></span></a> Ibid., 8</p>
</div>
<div id=edn5>
<p class=MsoEndnoteText><a href="#_ednref5" name="_edn5" title=""><span
class=MsoEndnoteReference><sup><font size=2 face="Times New Roman"><span
style='font-size:10.0pt'>[v]</span></font></sup></span></a> Ibid., 30</p>
</div>
<div id=edn6>
<p class=MsoEndnoteText><a href="#_ednref6" name="_edn6" title=""><span
class=MsoEndnoteReference><sup><font size=2 face="Times New Roman"><span
style='font-size:10.0pt'>[vi]</span></font></sup></span></a> FEMA
366 Hazus 99 Estimated Annualized Earthquake Losses for the United
States, February 2001, 16</p>
</div>
<div id=edn7>
<p class=MsoEndnoteText><a href="#_ednref7" name="_edn7" title=""><span
class=MsoEndnoteReference><sup><font size=2 face="Times New Roman"><span
style='font-size:10.0pt'>[vii]</span></font></sup></span></a> California
HealthCare Foundation, The Financial Health of California Hospitals, June 2007,
2-13</p>
</div>
<div id=edn8>
<p class=MsoEndnoteText><a href="#_ednref8" name="_edn8" title=""><span
class=MsoEndnoteReference><sup><font size=2 face="Times New Roman"><span
style='font-size:10.0pt'>[viii]</span></font></sup></span></a> Ibid.,
(interviews with key unnamed health care leaders), B-6</p>
</div>
<div id=edn9>
<p class=MsoEndnoteText><a href="#_ednref9" name="_edn9" title=""><span
class=MsoEndnoteReference><sup><font size=2 face="Times New Roman"><span
style='font-size:10.0pt'>[ix]</span></font></sup></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</p>
</div>
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