The issue of seismic safety at hospitals is of utmost importance to the future of patients who live in remote areas in California. As the CEO of a rural hospital, I know California's rural hospitals would love to build new hospitals if they could.

The problem is that the seismic legislation was enacted with a top-down, unfunded, one-size-fits-all approach, targeting the Goliaths of the industry without any legislative recognition of rural hospitals. This approach makes it extremely difficult for rural hospitals to get any targeted relief.

Rural hospitals have been pleading for a nuanced solution, one that takes into account the financial wherewithal of the particular hospital and the favorable engineering realities of smaller (often single-story) structures. Those isolated pleas have mostly fallen on deaf ears in Sacramento.

California's remaining 55 small rural hospitals are a lifeline for the isolated and remote communities they serve. According to the Center for Healthcare Quality and Payment Reform (CHQPR), nine rural hospitals have closed in California since 2005, such as the Madera Community Hospital closure, and another 13 are at risk of closing because of skyrocketing costs and decreasing reimbursement rates. This would leave only 42 hospitals to serve California's expansive rural areas.

I encourage everyone to read two recent CHQPR reports, "The Impact of the Pandemic on Rural Hospitals" and "Rural Hospitals at Risk of Closing." Rural facilities cannot afford burdensome seismic retrofitting requirements designed for large urban facilities.

Earlier this month, North Coast state Sen. Mike McGuire hosted an earthquake recovery town hall along with Assemblymember Jim Wood of Ukiah. Other participants included many Humboldt County leaders, representatives from the California Governor's Office of Emergency Services and Humboldt County Emergency Services. At the meeting, Wood discussed both Providence St. Joseph Hospital in Eureka and Mad River Community Hospital's resilience to earthquakes, saying that Mad River has "withstood earthquakes larger than this and not lost days of service."

It is imperative that any seismic legislation give due consideration for hospitals of differing size, structures, locations and abilities to avoid top-down legislation aimed at the largest and most able.

Douglas Shaw is the CEO of Mad River Community Hospital in Arcata and founded the Adult Day Health Center of Mad River. He is the president and chairman of the American Hospital Management Corporation.

This opinion piece was first published by CalMatters, a nonprofit, nonpartisan newsroom dedicated to explaining California politics and policy.