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.