Environmental review
Eight in ten full environmental reviews of California hospital projects found harm that could not be avoided. The projects were approved anyway
Few states ask what a new hospital building will do to the air, the traffic or the climate. California does, and its State Clearinghouse logs every step. Delgam read the record for 251 California hospital projects since 2000: how deep each review went, how long it took and what it decided.
· California State Clearinghouse (CEQAnet)
Source: Delgam's filings database. Federal reviews are of Veterans Affairs hospitals and FEMA flood rebuilds.
California files 53 of the 91 environmental reviews among Delgam's hospital filings.
Most state reviews of hospital projects ask about need, cost and size. Only a few states also require an environmental review of a private building. In eight of the states here the only reviews are federal ones, of Veterans Affairs hospitals. So this story follows California, where every review is on the record.
Since 2000, 137 of 251 California hospital projects with a review got a full environmental impact report.
A full environmental impact report (EIR) studies every effect and the alternatives. A negative declaration finds no significant effect, or none once the project is changed to avoid it (66 mitigated, 48 plain). Projects the law exempts, most renovations among them, file no review at all: in 2020–2022, at least 15 hospital projects filed only a notice of exemption with the state, against 35 that filed a review. Agencies can file exemptions with the county alone, so that count is a floor.
Writing the draft of a full review took a median 8 months.
That is the time from the notice of preparation, which opens an EIR, to the draft the public comments on, for 117 reviews. It was longest in 2015–2019, a median 10 months.
From notice to decision, a full review took a median 13 months; a negative declaration, 2 months.
The decision is the notice of determination the agency files when it approves the project. The 93 timed full reviews began between 2000 and 2025. The longest: Stanford University Medical Center Facilities Renewal and Replacement (SUMC Project), 3.8 years.
Noise, traffic and air quality top the list of issues a hospital review studies.
Each draft's notice lists the issues the review covers: construction noise and helicopters, cars and parking, dust and diesel. A listed issue means it was studied, not that the project was found to harm it.
Since February 2021, 69% of hospital reviews have listed greenhouse gases, against 61% of all California reviews.
The state's notice form added a box for greenhouse gases in March 2019 and for energy in February 2021, so earlier reviews could not list them, though the law has asked for a greenhouse gas analysis since 2010. Energy: 63% of hospital reviews, 50% of all.
Eight in ten full reviews found a significant effect, and the projects were approved with a statement that their benefits outweigh it.
When a review finds harm it cannot mitigate, the agency can still approve the project by finding that its benefits outweigh the harm. Of 92 decisions on full reviews, 77 recorded a significant effect, and 76 of those adopted such a statement of overriding considerations (the rest leave the question blank). 90 made mitigation a condition of approval.
Whether review makes hospitals greener cannot be told from the reviews alone.
Review summaries rarely name an energy commitment: eight projects mention solar power and none mention LEED certification, while 35 describe a central or cogeneration plant. The full reports hold the measures, and how the buildings perform after opening would take building energy data, which Delgam does not hold yet.
Look up a project
| Project | Hospital | Deepest review | Documents | Latest |
|---|---|---|---|---|
| Los Angeles County General Hospital Campus Master PlanLos Angeles · Los Angeles County Department of Public Works | Los Angeles General Medical Center | EIR | 9 | 2026-10-20 |
| Arrowhead Regional Medical Center Lot 1 Parking StructureColton · San Bernardino County | Arrowhead Regional Medical Center | Mitigated negative declaration | 4 | 2026-10-19 |
| Kaiser Permanente Medical Center - EIRRedlands · City of Redlands | – | EIR | 4 | 2026-10-13 |
| Final Subsequent EIR for the Update to 2018 UC San Diego La Jolla Campus LRDPSan Diego · University of California | – | EIR | 30 | 2026-09-17 |
| RUHS Medical Center Master Plan and Phase I Development ProjectMoreno Valley · Riverside County | – | EIR | 3 | 2026-09-01 |
| Arroyo Grande Community Hospital Rehabilitation Hospital ProjectArroyo Grande · City of Arroyo Grande | – | EIR | 1 | 2026-08-20 |
| Scripps San Marcos New Hospital CampusSan Marcos · City of San Marcos | – | EIR | 10 | 2026-08-20 |
| Peninsula Medical Center Replacement ProjectBurlingame · City of Burlingame | Mills Peninsula Medical Center | EIR | 8 | 2026-08-19 |
| Sutter Hospital Medical Center ProjectEmeryville · City of Emeryville | – | EIR | 1 | 2026-08-17 |
| Harbor-UCLA Medical Center Campus Master Plan ProjectLos Angeles County Department of Public Works | Harbor-UCLA Medical Center | EIR | 12 | 2026-08-05 |
| ORANGE COAST MEMORIAL MEDICAL CENTER PARKING STRUCTUREFountain Valley · City of Fountain Valley | Memorialcare Orange Coast Medical Center | Mitigated negative declaration | 2 | 2026-07-23 |
| Addendum No. 1 to the 2019 Hillcrest LRDP EIR for the Outpatient Pavilion and Parking ProjectSan Diego · University of California | – | EIR | 11 | 2026-07-16 |
| Martin Luther King, Jr. Medical Center Campus RedevelopmentLos Angeles · Los Angeles County Department of Public Works | – | EIR | 3 | 2026-07-09 |
| Garberville Community Hospital and Medical Office Building ProjectSouthern Humboldt Community Healthcare District | – | Mitigated negative declaration | 2 | 2026-05-05 |
| Kaiser Permanente San Rafael Hospital Modernization and Replacement ProjectSan Rafael · City of San Rafael | Kfh - San Rafael | EIR | 1 | 2026-04-27 |
| Kaiser Permanente Medical Center ProjectSan Marcos · City of San Marcos | – | EIR | 6 | 2026-04-16 |
| UCSF New Hospital at Parnassus HeightsSan Francisco · University of California | UCSF Medical Center | EIR | 6 | 2026-04-14 |
| Sutter Santa Clara Hospital ProjectSanta Clara · City of Santa Clara | – | EIR | 1 | 2026-04-08 |
| Riverside Community Hospital Expansion ProjectRiverside · City of Riverside | Riverside Community Hospital Amend 1 | EIR | 6 | 2026-03-05 |
| Railyards Specific Plan Update, KP Medical Center, MLS Stadium, & Stormwater Outfall Subsequent EIRSacramento · City of Sacramento | Kfh - Sacramento | EIR | 28 | 2026-03-05 |
| PLAN23-00021 - A Site Plan and a Conditional Use Permit - Desert Valley HospitalVictorville · City of Victorville | Desert Valley Hospital INC. | Mitigated negative declaration | 3 | 2025-11-19 |
| Department of State Hospitals Metropolitan Water Tanks #1 and #2 Replacement ProjectNorwalk · California Department of State Hospitals | – | Mitigated negative declaration | 2 | 2025-10-16 |
| St. Joseph Health System Mission Hospital ProjectMission Viejo · City of Mission Viejo | Mission Hospital Regional Medical Center | EIR | 4 | 2025-09-11 |
| Temecula Valley Hospital Master Plan Update and Planned Development Overlay AmendmentTemecula · City of Temecula | Temecula Valley Hospital | EIR | 9 | 2025-06-23 |
| Barton Health Hospital Project and South Shore Area Plan AmendmentsSouth Lake Tahoe · Tahoe Regional Planning Agency | – | EIR | 1 | 2025-05-06 |
How these figures were made
- Projects: every document in CEQAnet's lists of notices of preparation, draft and final EIRs, negative declarations and addenda filed since 2000 whose project or document title names a hospital or medical center, then every document under those projects' State Clearinghouse numbers. Titles were reviewed by hand: projects that only carry a hospital's name (a former hospital site turned to housing, a medical office building, a horse hospital) are left out, each with its reason logged.
- Review time: a review opens with a notice of preparation (for an EIR) or a draft, and closes with the next notice of determination within three years; revised and recirculated drafts belong to the review they revise. Every document of every project was read (single-document projects from the lists). CEQAnet refused requests three times; each time the reading stopped rather than retry, and it was resumed once, more slowly. Exemptions were read for 2020–2022; the next year's list was refused.
- Hospitals: matched to Medicare cost report hospitals by name and city, 124 of 251 projects.
- CEQAnet lists a contact person's name, email and phone for every document; none is stored. The methods page describes the rest of the database.