Critical care

How the debate over CPMC's controversial multi-hospital project revived the idea of healthcare planning in San Francisco

A big health care outfit has giant plans to transform SF's hospital infrastructure -- unless the city can demand a better plan

A complex and controversial project that would involve five San Francisco hospitals — including building a huge showcase facility for the wealthy atop Cathedral Hill — has prompted a debate about what average city residents need from the health care system.

California Pacific Medical Center, an affiliate of Sutter Health, proposes to downsize St. Luke's Hospital, which primarily serves a low-income population in the Mission District, as part of a $2.5 billion proposal to renovate and retrofit three existing medical campuses, close another one, and build housing and a megahospital on Cathedral Hill that would draw patients from around the country.

CPMC's grandiose plan was being considered strictly as a land use decision, despite its far-reaching impact on the city's health care system. So Sup. David Campos created legislation calling for the city to create a citywide health services master plan and to use that as another tool for gauging future medical projects.

Debate over that legislation left some activists on both sides unhappy, with progressives disappointed that it won't be able to stop a CPMC project they see as neglectful of the poor, and moderates wary of creating a new way to challenge development projects in the face of widespread unemployment in the construction industry.

But it struck a fine enough balance to win 8-3 approval by the board Nov. 16, enough to override a threatened mayoral veto. "I'm really happy and excited about the passage of this legislation," Campos told the Guardian after the vote.

The legislation has a two-part mandate, with the first part kicking in as soon as it has final approval. It requires the Planning Department, with input from the Department of Public Health, to prepare a health care services master plan to identify current and projected needs for health care services and where they should be provided.

The second part, which begins in 2013, requires Planning to determine whether medical projects are consistent with the findings of this plan. That delay is credited to a last-minute amendment Campos granted during a Nov. 15 committee hearing after the hospital industry complained that the process could jeopardize its ability to meet state-mandated seismic retrofitting deadlines for projects already in the planning pipeline.

The passage of Campos' legislation comes eight months after President Barack Obama signed the Patient Protection and Affordable Care Act. Hailed by its supporters as the most significant change to the U.S. health care delivery systems in 40 years, the reform package has also been greeted with criticism on both ends of the political spectrum. Progressives complain that it relies too heavily on private insurance companies and medical providers, while Tea Party supporters says that it's government run amok and they have vowed to "kill the bill." Senate Minority Leader Mitch McConnell (R-Ky) recently compared so-called Obamacare to "tyranny" in a speech to conservative legal scholars.

But here in San Francisco, the debate over Campos' legislation — as heated and divisive as it was at times — yielded a surprising amount of consensus around the long-neglected idea that government should play a role in health care planning.



The passage of Campos' legislation marks the first time in 30 years that a government entity has mandated health care services planning in California. That approach West Bay Health Systems Agency, whose creation he opposed as governor of California.

Lucy Johns, a San Francisco-based health care planning consultant who wrote the only health care services master plan California has ever had, recalls what happened in the mid-1970s after President Gerald Ford signed legislation that established health system agencies nationwide.


Thanks to the guardian, I am now aware that the new facility - excuse me - MEGA facility - on cathedral hill will be checking income levels before anyone is treated there.
Clearly the median income on cathedral hill = that of pacific heights so any MEGA facility built there will only be for the most massively rich people.

Posted by Guest on Nov. 24, 2010 @ 10:21 am

My friend J. recently developed acute appendicitis and had an appendectomy at one of the hospitals in this group. Without complications it cost him sixty thousand dollars. This is predatory health care and a disgrace to basic human decency. San Francisco doesn't need it. Neither does America.

Posted by Private Citizen on Nov. 24, 2010 @ 8:55 pm

Thanks to the Guardian, I am now filled with dread, fear, panic and anger—over unneeded involvement from an inept City Hall. If the vocal activist minority becomes even more vocal and stirs up enough worry and tsuris with absurd hypotheticals, enough people will freak out and demand... something, anything. And wannabe-Mayor Campos can win the day for just creating more committees, have lots of meetings, pull out the red tape and especially get lots and lots of "community meetings" where 20-30 people can shout all night, validating themselves in one big activist circle jerk.

Just think—everything we hate about centralized municipal transportation planning in San Francisco, now applied to centrally planned healthcare delivery. Maybe the Nurses Association should start learning how to become MUNI bus drivers. In a popularity contest, it's pretty neck-and-neck who San Franciscans are starting to hate more.

Jesus, just move these hospital projects along. Perfection is the enemy of progress. But maybe we need one more community outreach program.

Posted by Guest on Nov. 26, 2010 @ 1:22 pm

That is NEVER a good sign.

Posted by Lucretia Snapples on Nov. 26, 2010 @ 6:11 pm

What good has come from central planning in general in SF? Muni? This system of non-English speaking bureaucrats seems pretty inept on every level. Since the last big earthquake, a number of SF's few hospitals have been closed, including Childrens and Letterman. Where was the planning commission and the Bay Guardian then?

This juvenile sniping at the Van Ness hospital, which replaces the ugliest building in the City with a very valuable asset that will be essential during the next earthquake or major disaster, is absolutely absurd, particularly coming from the SUV driving, Starbucks latte swilling, white-guilt/self-righteous writers of this communist rag.

I'm all for socialism, but SF's government is far too incompetent to be insisting on 5 Year Plan micromanagement of industries it has little capacity to benefit. I've been to the People's SFGH several times, and ring up $40-70,000 bills related to a single broken bone or two. Healthcare costs are ridiculous everywhere, not just private hospitals.

If SF wants to micromanage other hospital systems, perhaps it should start with its own DPH, which isn't exactly a model of good stewardship. It's worse than many third world clinics I've visited, and costs more than the supposedly evil (non-union) private hospitals doing business in the City.

Posted by Daniel Eran on Nov. 27, 2010 @ 10:51 am