How the debate over CPMC's controversial multi-hospital project revived the idea of healthcare planning in San Francisco
"California established 14 health systems agencies, including the West Bay Health System Agency, which governed the nine Bay Area counties," Johns told the Guardian. "The legislation mandated that they be established by every state, with the federal government providing the funding. So every state had to decide how many, how big, and how structured the health system agencies would be."
Johns notes that state legislators were constrained when it came to the decisions these health service agencies made. "The governing bodies of the health systems agencies had to have a membership that was 51 percent consumer and 49 percent healthcare provider, which included doctors, nurses, and hospital administrators," she said.
That history served as a backdrop for discussion of the Campos legislation, with the Planning Department staff report noting, "With the elimination of the West Bay Health Systems Agency in 1981, there is no longer a routine or comprehensive analysis of health service resources, needs, trends, and local impacts conducted for changes to or within medical uses."
"It's truly a historic moment for San Francisco," Campos said after his legislation passed its Nov. 16 first reading (the second and final reading is set for Nov. 23, after Guardian press time). "We are the first city in the country to make sure land use decisions are aligned to our health care needs. That's an unprecedented step that will shape the future of healthcare planning for years to come."
Campos acknowledged that the passage of Obama's heath reform package — which includes a mandate to purchase private health insurance beginning in 2014 — was also a catalyst for his legislation, along with the CPMC project.
"But it had more to do with seeing that the city didn't have the tools it needed to evaluate projects in terms of whether they met the city's healthcare needs and how they might impact people's access to healthcare," Campos said. "The main catalyst came from the community, which felt it was being asked to make decisions that will have long-lasting health care implications, but didn't have any way to understand those needs. Those concerns were compounded by changes at the national level — and the recognition that these changes offer us an opportunity to engage in planning."
Campos' legislative victory came two months after members of the Cathedral Hill Neighbors Association joined nurses, medical workers, patients, and community groups in voicing concerns at a Sept. 23 public hearing about the draft environmental impact report for CPMC's Cathedral Hill hospital and the other facilities that are part of its proposal.
These groups collectively expressed fear that downsizing St. Luke's, closing the CPMC California campus, and transforming CPMC Pacific campus to an outpatient-only hospital will force low-income people to travel farther to access health care services while offering better service to the wealthy at Cathedral Hill. And neighbors worried that the proposed complex would increase traffic and require the demolition of rent-controlled apartments.
Formed in 1991 through the merger of Pacific-Presbyterian Medical Center and Children's Hospital of San Francisco, CPMC has been affiliated with Sutter Health since 1996 and currently has four medical campuses in San Francisco: Pacific in Pacific Heights, California in Presidio Heights, Davies in the Duboce Triangle, and St. Luke's in the Mission.
But CPMC's longtime goal was to build a facility intended to be like the Mayo Clinic of the West Coast, a 15-story, 555-bed full-service hospital and specialty care facility at the corner of Van Ness Avenue and Geary Boulevard. Company officials have made approval for that project conditional on keeping St. Luke's open in the face of the state's deadline on seismic safety standards that the hospital doesn't now meet.