Which way to the hospital?
Patients, staffers, and neighbors wrangle over the fate of S.F. General Hospital

By Tali Woodward

Seismic experts believe San Francisco General Hospital could collapse in the event of a major earthquake. So with a state-imposed deadline looming, the city must figure out how to save its sole public hospital, the only place where many disadvantaged city residents can get health care.

Right now three plans are being weighed, one of which involves relocating much of the health center to Mission Bay. And the debate about what to do is fracturing the community, pitting doctor against nurse and neighbor against neighbor.

Most of the doctors who staff the hospital like the idea of being smack-dab in the city's new biotech quarter at Mission Bay. But other hospital staffers, as well as Mission District and Potrero Hill activists, fear a move could make accessing health care even more difficult for many people who rely on the hospital.

Complicating matters further, a group of vocal homeowners near the current campus would like to see the hospital go, particularly if it moves ahead with a plan to install a helicopter-landing pad.

The process has been marked by the acrimony and second-guessing common to many major planning decisions in San Francisco. But in this case, if the rancor escalates, it might threaten passage of the bond measure necessary for any rebuild plan and could conceivably leave the city without a public hospital – anywhere.

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Following the 1994 Northridge earthquake, state legislators passed a bill with new stringent seismic standards for all of California's hospitals. The bill requires particularly vulnerable facilities – including S.F. General – to be either retrofitted or rebuilt by 2013. A detailed plan to do so must be in place by July 2007.

But any rebuild requires a massive infusion of money, and San Francisco Department of Public Health director Dr. Mitchell Katz has long said a bond measure needs to appear on November's ballot.

A 25-member steering committee was formed in 2002 to evaluate 43 plans for the hospital. The group is scheduled to endorse a single bond proposal Feb. 24, which will then be forwarded to the San Francisco Health Commission and later the Board of Supervisors for final approval. While the recommendation won't be binding, John Kanaley, the administrator overseeing the rebuild process for the hospital, told the Bay Guardian he expects the city to follow the recommendation.

The steering committee has narrowed it down to three plans, two of which would involve retrofitting and expanding current buildings on the Potrero campus, where the hospital has been located since 1872. (One of those would position a new hospital against the main gray building now housing the emergency room and wards; the other would build between the two brick buildings that flank the main lawn and would move the E.R. entrance from 23rd Street to Potrero Avenue.)

A third plan would relocate all the hospital's acute-care wards – as well as the E.R. – to a new site about two miles away at Mission Bay, while the outpatient clinics would remain on the current campus.

The hospital's medical leaders, all of whom are UC San Francisco doctors, have favored relocation from the start. They believe being at Mission Bay would broaden research opportunities and help attract high-quality students and staff. Though some proposals for the area – such as Mayor Gavin Newsom's middle-class housing measure, Proposition J, on the March ballot – are different, most of the development proposed for Mission Bay is related to science, medicine, and biotech.

Dr. Talmadge King, the hospital's chief of medical services, explained, "The center of the universe in terms of academic research will eventually be at Mission Bay." King dismissed concerns about accessibility, pointing out that the proposed location would actually be more convenient for patients who live in places such as the Bayview.

But King told us the medical leadership may reconsider its pro-move position now that the city, due to concerns about debt load, plans to draft a bond for only $550 million. That's one-third of the amount originally estimated for a comprehensive, state-of-the-art facility at Mission Bay, and it means that only the less-attractive split-campus plan would be financially feasible.

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Meanwhile, activists in the Mission and Potrero Hill are organizing to fight a move from their neighborhood. At a neighborhood meeting Jan. 14, they argued that many of the uninsured San Franciscans who rely on the hospital live nearby.

"My concern is if this hospital moves to Mission Bay, there won't be the same access," noted Concepcion Saucedo-Martinez, executive director of the Instituto Familiar de la Raza, which represents about 4,000 low-income residents in the city. "I'm not sure there's anyone even living there [at Mission Bay] yet, and when there is, I don't think it'll be poor people."

Many Mission residents wonder how all the old hospital buildings would be used – and worry about what losing the hospital might do to the neighborhood's businesses. They also have plenty of criticism for the Mission Bay plan, pointing out that a split campus will complicate care and that the acute ward would have 80 to 90 fewer beds if it's moved there. Relocating to Mission Bay would require more money to purchase land and possibly do toxic clean-up. Plus, the area is landfill, which is notoriously unstable in earthquakes.

Service Employees International Union, Local 790, which represents about 1,000 workers at the hospital, voted Jan. 13 to support a rebuild bond – but only if the hospital stays on the Potrero site.

"It's a big bond measure, and if we're not in full support, it's probably not going to pass," said Ed Kinchley, the health care chair for Local 790 and a social worker in the S.F. General E.R. "We really want it to be one that makes sense."

It's unclear what the union will do if the city pushes forward with the Mission Bay plan.

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The discussion is further complicated by a roiling controversy over plans to build a helicopter-landing pad at the hospital. Some of the hospital's neighbors are furious about the noise this would create; others dismiss their qualms as insignificant or, worse, as motivated instead by resentment for the poor patients who make up most of the hospital's clientele.

Official hospital sources say only that the helipad needs to be built immediately, no matter where the hospital will be 10 years from now. Out of the 25 largest cities in the United States, San Francisco is the only one that does not have air-medical access, and federal regulators have long recommended it be put in place. But the long-term location of the hospital remains most people's primary concern.

"I think it's a real treasure and do not think it should be moved," Sup. Tom Ammiano, who represents most of the Mission, told us. He added that the hospital needs "to do a lot more outreach than they've been doing," echoing a commonly expressed opinion at the Jan. 14 meeting.

Martha Hawthorne, a nurse who works at a community clinic in the Castro District and lives in Bernal Heights, asked, "What does is mean to have a community process when the folks who are affected don't even know?"

Kanaley told us that more than 39,000 flyers about the community input process were recently mailed to residents of the Mission, the Bayview, and Potrero Hill. But he said the hospital will do more, because with the bond, "we're asking for the support of the people of San Francisco."

"The location is an important issue," Kanaley said. "But the more important issue is to keep San Francisco General Hospital open."

The next neighborhood meeting on the rebuild is scheduled for Feb. 11, 6-8 p.m., 2789 25th St., Room 2001, S.F.

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