The future of St. Luke's Hospital

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The vision of a new CPMC-owned St. Luke's that may never happen

The CPMC hospital-rebuild deal is on life support -- and some say, to use the harsh medical code, it's CTD. Stands for Circling the Drain.

IF the arrogant leadership at CPMC and Sutter Health comes back in two weeks with a radically improved plan, and IF community groups get behind it, and IF the supervisors can trust Sutter enought to even consider it, then there's a chance this creature can be electroshocked back into the land of the living. But that's a lot of ifs. It's entirely possible at this point that the city and CPMC are so far away from agreement that the billion-dollar proposal for a fancy spankin new hospital on Van Ness will never happen.

We're all hopeful. As Emily Lee, an organizer with the Chinese Progressive Association, put it, "we're hearing a very different tone than they took before." CPMC is in something of a bind: Its existing main hospital on California St. doesn't meet state seismic standards, and has to be replaced or upgraded by 2015. And this isn't a typical business that can just pack up and move out of the city -- CPMC would lose far too many patients and too much money. So the crew there has to do business with San Francisco.

But it also has leverage over the city. Everyone in San Francisco agrees that St. Luke's Hospital in the Mission is a critical part of the city's health-care infrastucture. Everyone agrees that it has to remain open as a full-service hospital with emergency and acute-care facilities. And everyone agrees that it also has to be rebuilt (at a cost of about $250 million) and that it loses money every year.

Oh, and CPMC owns it. And threatens to close it down if the city won't move on the Van Ness palace.

 So Sup. David Campos has authored a resolution calling on city officials to start looking into Plan B: What do we do to save St. Luke's if CPMC won't put up the money to rebuild and operate it?

It's a tough question. CPMC, owned by Sutter Health, is a private nonprofit. The city could, in theory, seize the facility under eminent domain, and float a bond to pay for the rebuild and come up with $25 million a year in General Fund money to cover its operating loses, but that seems a stretch, particularly since the taxpayers have already approved a much bigger bond to rebuild SF General.

There are other health-care providers in the city, though -- and some argue that St. Luke's is only a money-loser because CPMC keeps shrinking its operations. "It's become too small to survive without a subsidy," Chuck Idelson, from the California Nurses Association, told me. And in theory, Dignity Health or even Kaiser could decide it was worth the investment to assume operations, particularly if the city joined in some sort of partnership to help. UCSF runs a big ol' hospital on Parnassus Heights, and already helps staff SF General with attending physicians and residents; maybe St. Luke's could be integrated into the university's medical training program.

"We need to explore what it would be like if St. Luke's was operated by someone who cared about the hospital for itself," Lee said. Unlike CPMC, which seems to care about it largely as a bargaining chip.

Joanne Jung, also with CNA, told me that "there has to be a St. Luke's. It's just too important to the city." And if CPMC doesn't want to keep it going, "clearly there has to be another operator., someone who has some decency and respect for the community St. Luke's serves."

Of course, nobody can force CPMC to sell the hospital or give it to another (competing) provider (although I suspect CPMC would be glad to get rid of it) -- and nobody can force Dignity or Kaiser to take it on.

The wildest idea I've heard is for the city to use bond money for the rebuild -- then let the health-care unions run it. A hospital run by hospital workers. Hospitals used to be run by doctors. But Idelson says CNA doesn't have anywhere near the kind of money that would be needed to upgrade and expand services -- and managing a hospital is a huge undertaking.

Chinese Hospital has its own nonprofit; maybe one gets created for St. Luke's.

But something has to happen, and we have to start thinking about it now. Otherwise, CPMC can continue to hold the city hostage.