New York Times – In Mission, Aging Hospital Is Seen as a Bargaining Chip

Rujey Rubacalva, a nurse, working in the emergency room at St. Luke’s Hospital on July 20. Credit Adithya Sambamurthy/The Bay Citizen

Rujey Rubacalva, a nurse, working in the emergency room at St. Luke’s Hospital on July 20. Credit Adithya Sambamurthy/The Bay Citizen

St. Luke’s hospital, in San Francisco’s Mission district, has been clinging to life for years.

The hospital is run down and lacks air conditioning. It is licensed to support 229 beds, but on an average day just 130 are filled. In-patient psychiatric care, occupational health services and care for the sickest newborns are no longer offered.

“We’re left with patients who are chronically ill or who don’t really have the resources or stamina for any aggressive treatment,” said Mary Michelucci, who has been a nurse at St. Luke’s for 35 years.

California Pacific Medical Center, which operates St. Luke’s, once planned to shutter the 139-year-old hospital and turn it into an outpatient facility. But California Pacific — a not-for-profit affiliate of Sutter Health, a Northern California hospital network — is keeping St. Luke’s open, using it as a bargaining chip in an ambitious strategy to overhaul how it offers medical care in San Francisco.

California Pacific has proposed a $2.5 billion development plan that includes a new 555-bed, one-million-square-foot hospital at Van Ness Avenue and Geary Boulevard on Cathedral Hill, while scaling back or renovating other facilities. California Pacific operates four of the oldest hospitals in San Francisco, including St. Luke’s, which now caters mostly to immigrants, the poor and the elderly. One-third of all emergency room visits in the city — and half of all births — take place at California Pacific facilities.

The center’s plan has led to a fierce debate about where hospitals should be located in San Francisco, and about whether California Pacific’s strategy to consolidate many services at one primary location would ultimately limit services for patients now served by hospitals like St. Luke’s, where almost 90 percent of all patients are on Medi-Cal or Medicare.

St. Luke’s “has to be a world-class hospital, not just an afterthought,” said Supervisor David Campos, who represents District 9, where the hospital is located. “We want to make sure that quality health care is accessible in an equitable way for all San Franciscans.”

Tom Ammiano, a Democratic member of the State Assembly, said he was watching closely to see what type of patients the new hospital would cater to.

“Cathedral Hill is looming,” Mr. Ammiano said. “Is that going to be a showplace or a place that treats every San Franciscan equally?”

California Pacific officials said the new hospital would draw patients from around the city and the country with state-of-the-art specialized services, including organ transplants. They say consolidating such services would enable the hospital to provide quality care for city residents.

“We don’t have the luxury of just looking neighborhood by neighborhood,” said Judy Li, a vice president of health system innovation and community benefit with California Pacific. “We are looking to build a system that is viable for all of San Francisco.”

Last week, the San Francisco Planning Department published a draft of the environmental impact report on California Pacific’s development plans. To meet state seismic requirements, California Pacific is pushing to win approval before the end of the year and break ground in January 2011 with hopes of opening by 2015.

Citing obsolescence and lack of demand, California Pacific had hoped in 2007 to turn St. Luke’s into an outpatient facility in 2007. A public outcry ensued. Some feared that nearby San Francisco General Hospital would be overwhelmed with patients. Others lamented that southeast San Francisco would lose important medical services.

A panel was convened to study the future of St. Luke’s, with participants ranging from the city’s public health director to community leaders. Following the panel’s recommendations, California Pacific agreed to keep St. Luke’s open as a community hospital. Yet, it hopes to do so on a smaller scale, proposing a new $250 million, six-story building with 80 beds to replace the main 12-story tower, which would be razed.

California Pacific administrators said St. Luke’s was currently larger than what the Mission needed. “To put a 200- or 300-bed hospital here would be insane,” said Geoffrey Nelson, director of enterprise development for the medical center.

On a recent afternoon, almost half of the rooms in the St. Luke’s intensive-care unit were vacant. Three visiting children played at an abandoned nurses station, where they spun on the chairs. The I.C.U. was treating just eight patients, although there were rooms for as many as 15.

Critics contend the Mission needs a sizable hospital , but aging facilities and service reductions keep more patients away — especially wealthier ones with private insurance coverage. Bob Prentice, director of the Bay Area Regional Health Inequities Initiative, a collaboration of public health officials and specialists, said California Pacific was keeping St. Luke’s alive to placate opponents of its development plan.

“Anybody who believes that they’re seriously investing in this hospital for any purpose other than to gain the political support that they need to get Cathedral Hill hospital is delusional,” said Mr. Prentice, the former director of the public health division at the San Francisco health department. “We want them to invest equitably in Cathedral Hill and St. Luke’s. They can relocate some of the beds to St. Luke’s and have specialty services there.”

The Coalition for Health Planning, a collection of more than 30 unions and political and community organizations, is calling on San Francisco’s Board of Supervisors to oppose California Pacific’s plans until they are revised to expand St. Luke’s and shrink the proposed new hospital. The coalition is asking that California Pacific commit to providing in-patient care for acutely ill patients for at least 40 years after St. Luke’s is rebuilt.

Advocates for St. Luke’s hope the city will press California Pacific to modify its plans.

“The big negotiation is going to be what concessions the City of San Francisco is going to be able to get from C.P.M.C.,” said Mr. Prentice, who was among the participants in the panel about the future of St. Luke’s.

Other groups, including the California Nurses Association, which is in a contract dispute with California Pacific, and the Chinese Progressive Association, also oppose the development plans. On July 15, opponents presented more than 1,000 postcards from local residents to St. Luke’s administrators, imploring them not to cut services.

“We need a hospital in the Mission. We need a hospital in the southeast,” said Teresa Almaguer, youth program coordinator for People Organizing to Demand Environmental and Economic Rights, a nonprofit group that helped organize the postcard drive. “We do not need them to move to an area where there is already a concentration of hospitals.”

Administrators hope that a smaller, rebuilt St. Luke’s will attract patients from wealthier neighborhoods like Noe Valley and Bernal Heights, helping to make the hospital more financially stable.

Ms. Michelucci, the nurse, was skeptical. “I just don’t see an 80-bed hospital being viable into the future,” she said. “And they’ll be able to do what they originally intended to do, which was to make us into a clinic.”

by Katharine Mieszkowski


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