August 7, 2012

CPMC's Pre-Construction Teams Sent Packing

With San Francisco's Board of Supervisors having voted to delay their vote to either affirm or overturn Planning's approval of CPMC's long-range development plans until November, a plugged-in tipster confirms CPMC has sent their pre-construction teams packing.

While likely a cost cutting move, along with a bit of political positioning, as our tipster notes, "Despite all the previous delays, this has never happened before."

Supervisors Affirm Commitment To St. Luke's, Delay On Cathedral Hill [SocketSite]
Planning's Approval Of CPMC's Plans Being Appealed This Afternoon [SocketSite]
CPMC’s Long Range Development Plan Renderings And Draft EIR [SocketSite]
The Billion Dollar Game Of Chicken Between The City And CPMC [SocketSite]
Cathedral Hill Hotel Demolition Paperwork Filed, Poised To Fall [SocketSite]

First Published: August 7, 2012 11:15 AM

Comments from "Plugged In" Readers

Wow. Time is money? Must be a complete shocker to the supes who operate in some sort of government specific "time is awesome" dimension.

Posted by: kg at August 7, 2012 11:44 AM

So a not for profit corporation wants to build a brand new hospital in SF where a condemned and ugly building currently stands. And it's being held hostage by SF over how much $ CPMC is going to give/donate/allocate to SF for the right to build a hospital. I can't say I understand this situation. This is a hospital!

Posted by: Matthew at August 7, 2012 11:59 AM

vote to delay = "we need bigger bribes?"

Posted by: EH at August 7, 2012 12:09 PM

This will be an interesting fight to watch. I think CPMC can agree to operate St. Luke's for 20 yrs. (even at a loss) if the City agrees to roll back/eliminate those development fees, low-income housing fees, bribe fees, etc.

Or everyone is waiting until November to see the national election outcome and whether Obamacare survives. If Obama wins, then there will be huge increase of covered patients/clients to justify the new hospital costs. If Romney wins and Obamacare will be gutted/significantly reduced, then there will be less incentive to spend that much money when SF already has a large number of hospitals.

Posted by: Live Smart at August 7, 2012 12:34 PM

^The impetus to build the new hospital is not to add to the existing hospital stock of SF, but to comply with the law that hospitals must be seismically safe by 2016 (or whatever the date is). The current hospitals that CPMC operates have to close at that time, which means that there won't be "a large number of hospitals" in SF without this one built to replace those.

Posted by: anon at August 7, 2012 12:44 PM

I was recently in Singapore, my first trip there in almost 4 years. They've built entire extensions to their city in the time it takes for us to approve one hospital - and some of that was on land that used to be the middle of the ocean. If ever there was proof that we need a benevolent dictator running our city, this is it.

This hospital would be finished sooner if I went out with a hammer and some nails and started building it myself.

Posted by: frog at August 7, 2012 1:06 PM

I would much rather see CPMC walk away from the deal entirely than give into extortionary demands from the city of San Francisco. Enough is enough already.

Posted by: zzzzzzzz at August 7, 2012 1:56 PM

Isn't there a specific deadline after which hospitals must meet the new, stringent seismic safety standards or be shut down? Doesn't that imply a limited window for approval?

Posted by: Mole Man at August 7, 2012 2:41 PM

In light of California's law all hospitals must be seismically safe by 2016, is there liability to San Francisco due to preventing CPMC from building a new hospital?

What happens if things remain deadlocked?

Posted by: Jackson at August 7, 2012 6:50 PM

Matthew- you have it wrong..CPMC is for profit, they are Sutter owned and profit driven...not a hint of non-profit going on there.

They are wee known for and ruthless in taking over hospitals and cutting services, while making empty promises to gain traction.

When they took over Children's Hospital, now known as their California Campus, they shut down the Emergency Room and would no longer receive ambulances, routing them instead all the way across town to their Pacific Campus.

When they took over Davies Hospital in the Castro they slashed programs and eliminated the majority of their AIDS services in a neighborhood that desperately needed and relied on those services.

Without a doubt, they will eliminate majority of services and close the ER at St Luke's if the SF Board does not hold them accountable and stand strong in requiring them to keep St Luke's operating at full potential with ER via a binding contract.

Posted by: Jd at August 7, 2012 6:56 PM

I really think CPMC should do like the Chevron Refinery is planning. Just shut it down and move to a different location away from this type of involvment.

Posted by: guest at August 7, 2012 8:41 PM

All the way across town to the Pacific campus? What is it, 12 blocks? Horrors.

Posted by: Scooter at August 7, 2012 10:15 PM

I've been a patient at CPMC three times, twice at their Pacific campus which has an Emergency Department and once at their California campus -- they are both fine and perfectly adequate. My other family members use UCSF.

When I say, there are already a lot of hospitals in SF, I mean St. Mary's, St. Francis, UCSF (Mt. Zion, Parnassus, Mission Bay), SF General, CPMC, Chinese Hospital, and Kaiser. How many residents are there in San Francisco to justify this many hospitals?

Posted by: Live Smart at August 7, 2012 10:26 PM

^Just over 800,000.

Posted by: anon at August 7, 2012 10:30 PM

I still don't quite understand why St. Luke's is such a sticking point. They're rebuilding it, aren't they? So, worst case, they'll build a state-of-the-art hospital and put it up for sale to the highest bidder?

Is it that emergency rooms are money-losers? I wonder what effect Obamacare will have (if any) on the situation.

Posted by: Alai at August 7, 2012 11:42 PM

St. Luke's has ALWAYS lost money simply due to demographics of the surrounding neighborhoods. Too small for economies of scale, too many medicaid patients or patients without legal immigration status, too few private payer insurance patients, and not even enough Medicare patients. Private payers subsidize Medicare (80% of cost), Medicaid (~60% of cost), and no insurance or illegal (lucky to get ANYTHING). It doesn't qualify for Critical Access Hospital $$$ from Medicaid or Medicare due to SF General drawing away those types of patients. Quite frankly, it is excess hospital capacity in an area of town that cannot financially support a hospital. To keep St. Luke's running as it is, CPMC sends patients from all over the city to St. Luke's for obstetrical ultrasounds even if they are closer and would rather go to another hospital. Even this is less than successful as St. Luke's is not well served by public transit or convenient location for most of San Francisco and patients are free to go to competing hospitals.

Yes, they are rebuilding St. Luke's, but I would guess that they are revamping it as a same-day surgery center with the minimum other services required to maintain the ER they would like to get rid of. The ER makes no sense in that location considering anything serious is diverted to SF General as the city's level 1 trauma center which is 15 blocks away. So instead it is full of patients who do not belong in an ER or hospital but are treated there since they cannot be legally turned away. They get worse care and it costs much more than they should have received if they had been treated by the proper front line PCP, urgent care, mental health, addiction specialist.

Posted by: 94123_native at August 8, 2012 11:06 AM

Just a note, while the Cathedral Hill process has been dragging on and on and on, SF General and UCSF Mission Bay Hospitals are both happily into construction. It is not that a hospital cannot be built in SF (2 big ones are being built right now) but that Sutter/CPMC cannot get one built.

Posted by: Helmut at August 8, 2012 11:14 AM

94123_native stated:
"Private payers subsidize Medicare (80% of cost), Medicaid (~60% of cost)....."

From where are you getting your information regarding Medicare 80% of costs being subsidized by private payers?

I believe you are mistaken.

Private insurers such as Healthnet, Blue Cross, Aetna, Cigna have negotiated discount pricing off of list that are similar to Medicare, etc.

A physician friend of mind says he actually receives more money from Medicare patients than some reimbursements from private insurers.

The problem with St. Lukes is too many patients without ANY insurance.

It is a well known fact in the community that everyone presenting at an Emergency Room must be treated, even they cannot afford care.

The back and forth negotiations between the City and CPMC (Sutter) are due to who is going to pay for continuation of medical treatment.

(BTW, I am in the medical field)

Posted by: Jackson at August 8, 2012 12:12 PM

Helmut,
I believe that UCSF did not need to discuss their plans with the city since they are sort of like the Vatican: independent city/state. The city owns SF General so that project was either not reviewed or sailed through the process. I don't think that either example is an apples to apples comparison of the CPMC situation.

94123_native,
I gave birth at CPMC and was not sent to St. Luke's for an ultrasound. St. Luke's has a well known natural birth center with midwives that is becoming more popular with SF women. They should be expanding/marketing the midwife program to help St Luke's.

I do believe the CPMC plan includes closing St. Luke's ER and turning the facility into an urgent care center.

Posted by: sashi at August 8, 2012 2:44 PM

The California State Law that is driving the make over of so many hospitals in the state is SB 1953. This was the driver for the Laguna Honda rebuild, and the ongoing SF General rebuild.

http://www.oshpd.ca.gov/FDD/seismic_compliance/

Note that the original deadline was 2013. Like many plans that the economic downturn changed, that deadline is now a moving target.

Another more subtle impact is the decision by some hospital administrations to not replace or seismically strengthen existing buildings but to convert their use from pure hospital (I occupancy in code language) to admin or outpatient facilities (B occupancy in code language) which then do not require the seismic upgrading by law.

Some of the seemingly random chess like moves of hospital departments from one site to another you see in big healthcare groups is being driven by the effort to find the best, or lowest cost combination of new construction, down-to-the-studs existing building upgrades and existing buildings left as-is to house all of their ongoing services.

Sutter is note worthy as a for-profit healthcare system. I am sure they would like to shift all of the hospital functions away from St. Luke's and use it for outpatient services only to avoid all full OSHPD seismic upgrade.

Posted by: redseca2 at August 8, 2012 4:01 PM

Why does everyone keep saying that Sutter is for-profit? It's a non-profit like almost all other big hospital orgs - that's not to say that they're not motivated by money, but simply that it's absurd in this day and age to not set up hospitals as not-for-profit enterprises and then just raise salaries through the roof (but no profits, see!)

Posted by: anon at August 8, 2012 4:15 PM

I know first hand that this delay will cost people their jobs. Also, if the citcactuses this deal to collapse, it will guarantee St. Luke's closure by the state for not meeting seismic requirements. Also, for those that mentioned SF General and UCSF's new hospitals, they are under construction because they did not require rezoning, thus the city was not involved in granting entitlements. The actual construction permit comes from the state.

Posted by: Ano at August 8, 2012 4:59 PM

Sutter does plan to rebuild St. Luke's as a new acute care hospital. The question is how long Sutter should be committed to keep the hospital as a hospital if it doesn't mark money. The differences between the city and Sutter are small right now-- and hopefully these can be bridged in mediation.

Posted by: Dan at August 8, 2012 5:00 PM

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