Dr. Bonita Palmer has worked at the embattled St. Luke's Hospital on the southwest corner of César Chávez and Valencia for 17 years.
Before a packed room of union organizers and religious leaders Sept. 12 at St. Mary's Cathedral near Japantown, she gave a brief speech about her experiences at the beloved but financially troubled hospital.
"St. Luke's has been struggling to stay afloat for many years," Palmer told the audience. "Under managed care, reimbursements are down, the numbers of uninsured patients are up, and the growing gap between income and cost of care stresses the health of working people."
Money woes at St. Luke's are no secret. Its parent company, California Pacific Medical Center, an otherwise lucrative group of San Francisco hospitals owned by Sacramento's Sutter Health, describes the losses at St. Luke's as anywhere from $20 million to $30 million annually.
Patient advocates and unions representing St. Luke's workers have long feared closure of the hospital and its badly needed acute-care services, which thousands of residents the city's poorest among them, living nearby in the SoMa, Mission, and BayviewHunters Point neighborhoods often visit when they can't get expensive medical treatment elsewhere.
The hospital continually faces cuts executed by the CPMC, from its downgraded neonatal nursery to the subacute unit, where, Palmer says, patients who require nonemergency but highly specialized care from professionals are being turned away. "Sutter scrapped its plan for a much-needed upgrade to our emergency room even as we continue to receive the overflow of patients from" San Francisco General Hospital, she said.
Staffers learned most recently that outpatient physical therapy, which had already been trimmed, will be done away with completely, while the hospital's 36-bed inpatient psychiatric unit and outpatient clinic have already been closed. A woman in the audience confessed afterward that she was nearly brought to tears by Palmer's tale.
The decisions only worsened Sutter's reputation across Northern California for dwelling on its bottom line and further enraged the United Healthcare WorkersWest union, which represents thousands of Sutter workers and with which the company has regularly battled for a decade.
St. Luke's contains one of the most active emergency rooms in the city, and aside from General Hospital a mile or so away on Potrero Avenue, it serves more patients benefiting from Medi-Cal and Sutter's version of charity care services than just about any other facility.
The CPMC, which fully merged with St. Luke's in January, promises the hospital will be a part of the company's future. But the CPMC also comes closer every day to beginning construction of a new $1.7 billion hospital on Cathedral Hill, closer to the city's wealthiest neighborhoods. And critics worry that CPMC's new bid proves not only where its priorities are but also that once-independent St. Luke's opened in 1871 by an Episcopal minister will suffer death by a thousand cuts.
Sup. Tom Ammiano, who's closely observed the fate of St. Luke's for years, says the CPMC is slowly amputating one of the few hospitals left in the southern portion of San Francisco while paying lip service to nonprofit health outreach.
"They lie without guile," he said. "Waterboarding would be more enjoyable than dealing with these people."
Sutter initially took over St. Luke's in 2001 as part of a settlement agreement after the hospital sued Sutter in 1999, alleging state antitrust violations in Sutter's brokering of an exclusive contract with the Bay Area's largest network of doctors. St. Luke's officials claimed the contract stripped wealthier patients away from the hospital, which hurt its bottom line.
The settlement required Sutter to bankroll St.
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