By 2030, all hospitals that provide acute care services in California must meet the state’s strict seismic guidelines or face severe consequences. 

California Senate Bill 1953 was enacted in 1994 following the Northridge earthquake, which caused more than 60 deaths, 9,000 injuries and the loss of 50,000 housing units. The state’s hospitals today must meet strict seismic building codes so they remain operational when natural disasters strike.

But these requirements pose major financial and logistical obstacles for hospital systems, said Patrick Chan, executive vice president of development solutions at BKF, a California-based engineering, surveying and construction management firm.

It’s estimated that complying with these regulations will cost California hospital systems up to $143B, with many forced to retrofit their buildings extensively or build entirely new ones. 

If they do not meet these requirements, they risk their acute care services being shuttered. This would have serious adverse effects, not just on a hospital system but communities at large, Chan said.  

“Communities want those healthcare campuses to be embedded within their neighborhoods,” he said. “They're not just medical facilities. They're wellness hubs and are an extremely vital service to any region.”

But bringing these buildings up to code and designing the critical infrastructure is not only a financial burden — hospitals have to determine whether the surrounding infrastructure serving their facilities can support a rebuilt or expanded campus, Chan said. This is no easy task.

“If healthcare systems are going to put up billions for these projects, they want to make sure it’s going to be as resilient as possible,” he said.

BKF works with hospital systems on projects designed to achieve NPC-5, California's highest nonstructural performance standard for acute care hospitals, which addresses whether critical equipment and utilities can support operations for at least 72 hours after a disaster. This work often involves upgrading water, wastewater and emergency power infrastructure, Chan said.

All Department of Health Care Access and Information acute care facilities can't stop tending to their patients while renovations take place, and emergency access and operations must be maintained 24/7.

That’s why construction must be carefully phased to keep critical services up and running without delay — whether the plan involves upgrading current infrastructure or building a new building. 

"Many of our healthcare clients face a key constraint, where limited space has made phased construction particularly important," Chan said.

New campuses are being proposed by all healthcare operators across California, from planning large-scale acute care hospital replacement projects to replacing aging facilities that will soon fall out of seismic compliance. In many cases, once the new campus is open, the old one will be converted into medical space, Chan said.

"A lot of times, existing campuses are located in core urban areas, so there's not a brand-new site to build on," he said. "There's a phasing element required that involves taking down a portion of the site to build what is needed, and then eventually repurposing the existing hospital. From a cost perspective, it often doesn't make sense to retrofit an existing building."

This is a classic example of what many hospitals are opting to do: reuse the site but not the building. The site location and surrounding infrastructure of older buildings often can't be upgraded to the new standards, Chan said.

For BKF, the work starts well before shovels hit the ground, he said. BKF works with healthcare systems and their investors early in the planning process to identify infrastructure, cost and scheduling constraints. 

“Our engineers could prepare 15 different packages to be able to make sure we phase in exactly the right order to ensure a smooth and timely delivery,” he said. “We know that each campus has its own needs, so we provide a comprehensive suite of planning, engineering, surveying and construction management services.”

BKF has been in business for 110 years in California and was named ENR West's 2026 California Design Firm of the Year. With more than 900 people across 20 offices in the western U.S., the firm prides itself on being more than just a consultant, Chan said.

Beyond its in-depth knowledge of the state’s seismic requirements for healthcare facilities, the firm embeds its engineers alongside its clients to help solve infrastructure challenges. This approach allows the team to put itself in the shoes of the patients, caregivers and hospital staff to consider how every decision it makes affects their experience, Chan said.

A recent example is Sutter Health’s new Emeryville campus in the East Bay, Chan said. The healthcare network bought a 12-acre, partially developed life sciences campus from BioMed Realty in 2025. The plan is to renovate two existing buildings for outpatient and specialty care and construct a new hospital that will replace acute care services provided at the Alta Bates Ashby campus in Berkeley, which does not meet California's seismic standards.

But to make this happen, Sutter needs to convert buildings originally planned for life sciences uses to not only serve as a community health hub but also to make sure its new hospital building meets the state's stringent seismic requirements, Chan said. The healthcare system is investing more than $1B to complete this transformational project. 

With stakes like these, BKF is approaching its work on this project a little differently.

“We’re participating in big room colocation, where we send our engineers to work on the site full time alongside the client and the multidisciplinary delivery team,” Chan said. “When you have teams that are placed together and collaborating in person, it helps you identify issues quicker. Deploying tools such as Lean principles and adapting to our client's preferred form of project-delivery methodology allows decisions to be made quickly to stay on schedule and in budget.”

Because BKF previously handled entitlements for BioMed Realty, it already understood what the site could support, Chan said. This allowed BKF to tell the client what would work on the site and what wouldn't.

“Our involvement early on helps drive some of those relocation factors because it helps the healthcare systems understand, based on their capital expenditure, what they're going to need to be able to build to support the site,” he said.

Given the size and scale of investments like these, Chan said hospital systems are increasingly looking beyond simply meeting the 2030 requirements and considering how new facilities can withstand future disruptions. “Future-proofing” is now a main priority, he said.

And that starts from the ground up, Chan said. Before the project can go vertical, hospitals must first ensure the horizontal infrastructure can support what comes next. 

This article was produced in collaboration between BKF Engineers and Studio B. Bisnow news staff was not involved in the production of this content. 

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