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Federal Inaction: The Potential Impacts of Eased Building Regulations

Since coming into office in January 2017, President Donald Trump has revoked federal policies that required minimum resiliency standards on critical infrastructure projects — impacting everything from hospitals to power generation plants. Modern Healthcare spoke with NBBJ Partner Mackenzie Skene about what the loosened Obama-era building regulations mean.

MH: What precedent does this executive order set?

MS: President Obama’s Executive Order — which was signed in 2015 — made it the official policy of the U.S. Government to improve the resiliency of communities against the impact of flooding. This included special requirements for federally-funded healthcare projects: including adding three feet to base flood elevation when building hospital facilities. This is due to growing research that shows climate change will cause hurricanes of greater intensity, as well as increased risk for flooding in coastal communities across the United States. Unfortunately, President Trump revoked this policy on August 15, 2017.


MH: How will rolling back these regulations impact providers?

MS: Healthcare systems in the United States face a myriad of challenges, including increased operating costs, switching to a value-based reimbursement model, an uncertain political environment and rapidly advancing technologies. So it’s understandable that hardening against climate-caused disasters may fall to the bottom of the priority list. But we’ve seen what can happen when that is the case. 


Take for example Hurricane Katrina. Flooding during that disaster closed over half of the region’s hospitals and all of them in New Orleans itself immediately after the hurricane. Over a decade later, some of the facilities remain closed. We saw a similar event after Hurricane Sandy in New York City, which damaged numerous hospitals, including five which remained closed a month after the disaster hit.

Hurricane Harvey | by europeanspaceagency

Even after these storms — which killed at least 1,400 people and caused $183 billion in damage — there are relatively few protections in place that safeguard healthcare facilities from storms. We believe the solution to creating more resilient healthcare facilities requires a partnership between healthcare institutions, government agencies and professionals in the building industry. We also believe that additional regulations are not always the right answer. But we are concerned with President Trump’s decision to revoke the executive order without adding any protections or considerations in their place.


MH: How much of a difference does one foot make?

MS: In a flood event, every foot counts. Building three feet above flood elevation — as was suggested by President Obama’s regulations — could mean the difference between full hospital functionality and a complete failure of electrical, plumbing and mechanical systems.


My firm worked on two major hospital replacement projects in New Orleans after Hurricane Katrina. There, we instituted an “upside-down hospital” design strategy which placed critical infrastructure typically relegated to the basement high above the flood stage, in some cases seven floors up. At University Medical Center in New Orleans for example, the first “mission critical” floor is located 21 feet above base flood elevation.


MH: Would the regulatory roll back save providers money?

MS: While it’s possible the roll back of President Obama’s regulations will save money in the short term, it will likely cost healthcare systems more in the long run. A study by the National Institute of Building Sciences found that for every $1 of public funds spent on disaster mitigation, it saves society $4. LSU’s Hurricane Center also found that stronger building codes related to wind damage before Katrina would have saved $8 billion alone. It is generally cheaper to retool infrastructure before a disaster hits.


MH: Will the firm follow the old regulations even though they’ve been rescinded?

MS: Only projects with Federal involvement were covered by President Obama’s Executive Order. On Federal projects today, it will require the client’s approval to exceed the current requirements.


MH: Are there current projects the firm is working on that it has to amend given the change?

MS: We are working with healthcare facilities impacted by the change, particularly on the Eastern Seaboard.


MH: How many organizations could this regulatory change impact?

MS: This regulatory change impacts federally-funded hospitals in flood prone areas. But it also extends to other types of projects, including assisted living facilities and even power generation facilities.

Mackenzie Skene is a healthcare partner at NBBJ

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