Needed: a public health master plan

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California Pacific Medical Center's plan to build a massive new regional hospital on Van Ness shouldn't be under the jurisdiction of the Planning Commission

EDITORIAL More than 100 people showed up at the Planning Commission Sept. 23 to oppose California Pacific Medical Center's plan to build a massive new regional hospital on Van Ness Avenue. Most were neighborhood residents who raised an excellent point: what, exactly, would the shiny new $2.5 billion hospital offer for low-income people in the Tenderloin?

And that's just the starting point for discussion. The new project is a piece of a much larger plan: CPMC wants to shut down part of its Laurel Heights campus, reduce the number of beds and the scope of service at St. Luke's, turn Ralph K. Davis into a specialty facility, and reshape the way health care is provided in San Francisco.

That's a huge deal — but right now, the city is looking at the projects piecemeal. That's poor public health policy and poor land-use planning. In fact, there's no real way to evaluate the Van Ness hospital in its proper context — the Planning Commission, which will rule on the development issues, is hardly the best venue in which to discuss the future of health care in San Francisco.

So new legislation by Sup. David Campos is critical to injecting some sanity into this, and the larger, health facilities debate. The Campos legislation would mandate a citywide Health Care Services Master Plan and would require that all new hospital development, public or private, be consistent with that plan. It's a pretty basic concept, and it's hard to imagine that nobody's suggested this before.

San Francisco has a large, complex network of facilities providing health care — a big public hospital, a university hospital system (University of California San Francisco), a series of public and nonprofit community clinics, half a dozen private hospitals run by two competing chains (CPMC and Catholic Healthcare West), and one health maintenance organization (Kaiser). Some provide unique services, some provide competitive services — and there are some critical services that are hard to find anywhere.

It's hard to say whether the city needs what CPMC is proposing — a gigantic medical center that some have described as the Mayo Clinic of the West, designed to attract patients from all over the region — without any sort of overall plan. How would the new facility and the CPMC restructuring affect services at St. Luke's, a critical part of the health care infrastructure in the Mission? Where would patients who rely on Davies for emergency and clinical care in the Castro district wind up? How about all the medical office buildings and doctors' offices situated near hospitals that are about to change?

How will CPMC's moves affect low-income-patient care? How does the project fit in with the new Obama health care policies and the city's own Healthy San Francisco program? Will a new hospital on Van Ness increase access to primary and emergency care for residents of the Tenderloin — or will they be shuttled somewhere else while the high-end facility caters to better-off patients seeking expensive specialty procedures?

Those aren't land-use decisions — and while some Cathedral Hill residents argue that the new hospital will cause traffic problems, the biggest issues go beyond the scope and expertise of the city Planning Department.

Under the Campos bill, the Public Health Department would develop a master plan (which public health director Mitch Katz says can be done with existing resources), the Health Commission would review that plan, hold public hearings, and sign off on it — and city planners and health officials would have to make sure that new health-related development met existing and future public needs.

The supervisors should pass the bill and get the process going as quickly as possible. And they should refuse to sign off on any final version of the hospital plan until there's a city framework in place — or at the very least, until CPMC can demonstrate that its citywide infrastructure plans are designed to meet public health needs. *