As the fate of St. Luke’s Hospital in San Francisco’s Mission District lies in critical condition with the looming closure of its inpatient emergency services, SF State’s nursing program risks losing an important satellite campus.

At a committee hearing before the San Francisco Board of Supervisors on Oct. 25, California Pacific Medical Center, the non-profit medical group that owns St. Luke’s, outlined their plan for transferring acute care services to a proposed $1.7 billion dollar hospital on the more affluent Cathedral Hill neighborhood at the corner of Van Ness Avenue and Geary Boulevard.

It is a move that SF State school of nursing director Shirley Girouard said is part of a nationwide trend where hospitals in underinsured communities—such as the Mission—are forced to cut services because of the lack of adequate compensation.

“It’s particularly hospitals in low income neighborhoods,” Dr. Girouard said, “Because of the financial difficulties, they don’t have the clientele that pay at the same rate as wealthier neighborhoods that are highly insured.”
Coupled with hospital closures, a nursing shortage puts nursing schools in a precarious dilemma, according to Girouard. As Bay Area colleges continue to take on more students to fight the shortage, they are increasingly hard-pressed to find hospitals for students to take their clinical requirements at.

“It makes it very difficult to expand [the nursing program] at all because we have nowhere to take them,” Girouard said, “We send our students as far away as Stanford to get their clinical experience.”

Jena Barrios, 20, an SF State nursing student in her first semester in the program said that a possible closure would make it even more difficult to complete her training.

“It’s hard to find place places to go for your clinical rotation,” Barrios said, “We’re in competition with other schools’ nursing programs and it would be inconvenient [to go elsewhere] because [St. Luke’s] is so close.”

Diana Karner, chief nursing officer for CPMC, acknowledged the nursing shortage, adding that while more nursing students are being trained through school programs, many professional nurses are on the edge of retirement.

However, Karner said that while changes at St. Luke’s are likely, patient load and the need for nurses at its other San Francisco campuses would increase.

“If the nursing schools are flexible with when the students can get clinical rotation, we’ve been willing to do whatever we can to provide them that,” she said.

City officials, on the other hand, are weary about CMPC’s ability to close up the health disparity gap in the South of Market area.

Public health director Mitch Katz testified on Thursday that the move would leave San Francisco General Hospital as the only hospital with long-term inpatient care in the south-east side of the city.

“I don’t believe a simple closure of St. Luke’s, and closure of the [emergency department] could enhance our health status” Dr. Katz said. “We only now have nine acute care hospitals in San Francisco and we very badly need all of our emergency departments.”

During the hearing, city Supervisor Michela Alioto-Pier grilled CMPC executives on rumors of sabotaging St. Luke’s numbers in order to justify the downgrading.

She asked if CPMC was referring patients with private insurance to its other campuses and holding on to billing statements for its Medicare/MediCal claims—ideas that Christopher Willrich, CMPC vice president of strategy and business development, categorically denied the accusations.

“There’s no understanding that this is the way things are done,” Willrich said, “This doesn’t not sound like CPMC.”

According to Willrich, St. Luke’s is currently losing $30 to $35 million each year while 60 percent of its acute hospital beds lay empty on any given day. He added that 85 percent of the hospital’s emergency room visits are for “low-level” emergencies such as asthma attacks and diabetes complications.

Still, Alioto-Pier expressed her concerned on the impact the closure would have on the neighborhood.

“You get rid of St. Luke’s and women who want to give birth to their babies in their communities all of a sudden have to go into Pacific Heights,” the supervisor said.

St. Luke’s doctors, who treat high number of patients on government programs, also had their questions about the potential loss of the hospital.

Michael Treece, chairman of the department of pediatrics at St. Luke’s has cared for children in the Mission District for over ten years. He noted that kids get sick at higher rates than adults and more serious conditions could develop into life-threatening complications if not dealt with properly.

“Do we really want to ask families to bring their sick children all the way across town on a bus,” Treece asked during open public comment.

33-year-old Jan Zimmerman, who recently delivered her baby at St. Luke’s, said the hospital should remain open as an example to the rest of the nation. She said that San Francisco should be home to hospitals that provide “the same opportunities and resources so that we have the best kind of healthcare available for everybody.”

The strong community reaction seemed to take stock with CPMC chief executive officer Dr. Martin Brotman, who stayed for the entirety of the three-hour hearing. He said while he found the medical redlining accusations to be insulting, he thought the dialogue was constructive.

“Everybody said we’re running a terrific hospital in there and they don’t want to lose it, that resonates,” Dr. Brotman said, “I heard what they’re saying and I’m going to reassess what the options are.”

Brotman said CPMC will continue to work with Dr. Katz and the city to determine the future of St. Luke’s and San Francisco’s medical system.