While our coalition supports Mayor Lee’s demands of Sutter CPMC, we feel they do not go far enough to ensure that CPMC is rebuilt the right way.  We believe he should stand firm on these demands and should push Sutter to pay its fair share for charity care, affordable housing, etc. as a tax-exempt nonprofit organization. We also believe that he should support the community and labor’s demands that Sutter/CPMC should be accountable to the community by signing an enforceable Community Benefits Agreement that is negotiated transparently with real community input and accountability.

CPMC, the largest and most profitable operator of hospital beds in San Francisco, has plans to redesign their system in a way thatClick to view slideshow. would dramatically impact our City’s healthcare services for decades.  What we are asking for is that Sutter/CPMC, like every major developer in San Francisco, help offset the impacts of its new expansion and maximize its benefits for the City of San Francisco.  This involves committing to standard levels of healthcare service to the poor, committing to a viable St. Luke’s Hospital for the medically underserved Southeast sector, mitigating its enormous impact on the demand for affordable housing by its workforce, preventing a trafficnightmare on Geary and Van Ness, and ensuring good jobs for San Franciscans and basic rights for its workers.

We are asking that Sutter Health and CPMC receive no special deals.  Sutter must pay its fair share.  Rebuild CPMC the right way!

Our community and labor coalition applauds Mayor Lee’s initial steps to ensure CPMC is rebuilt the right way.  We ask him to stand firm on his demands that Sutter pay its fair share as a tax-exempt nonprofit organization.  By asking to be exempt from the City’s expectations, Sutter’s CPMC is asking for special treatment in a backroom deal.

We wonder if Sutter/CPMC will invest in the long-term health of this neighborhood by agreeing to strong First Source arrangement for the permanent jobs. Much of the debate around local hiring practices has focused only around construction and trade jobs-not on the jobs that will be around for decades !!!

The tenderloin is a diverse place with Asian,Latino,Black,White, and immigrant communities. There are many people ready for jobs,good people with families and kids to look after. There are many great Employment and training programs to help become Chefs,Desk Clerks,Support service workers,and Maintenance workers. However, there are just not enough jobs for the graduates of these programs.

Sutter/CPMC is in a perfect position to help us do something about this problem. We want a percentage of the permanent jobs. We know that the hospital will hire from all over the city and region – but they are coming to our neighborhood so we need to be hired! Without a binding agreement we fear our communities will be left out in the cold. We need to be chipped in not locked out. We don’t need charity, we need jobs and opportunities.

Unemployment can make a mental patient out of you – you can be sure of that.

The truth is that we need jobs there in our community. Why can’t we get jobs? Why can’t we get the jobs needed for survival? There are Plenty people who are qualified to do the jobs but unless we remind them,I don’t think we’ll get them. We  have to stay the course and do whatever we need to do to get these jobs. Unemployment it demoralizes people it can drain our thirst for living. Your kids don’t eat well, it effects your physicial health. Parents need jobs to feed their children. Sutter is coming to our community so why can’t we get a break?

Tenderloin Boys and Girls Club 

The Tenderloin Clubhouse opened in 1996. The Club is located on the ground floor of a Mercy Housing complex, and is spread out over three non-contiguous spaces. The Club has had an enduring and successful partnership with Mercy Housing and participates very actively throughout the Tenderloin community. This Club has consistently been one of the strongest Clubhouses in the BGCSF system. It is the second smallest of BGCSF’s sites, but has had great success serving youth of all ages.

La Voz Latina

La Voz Latina works with Latin American immigrants in the Tenderloin to develop leadership skills and foster civic engagement.  We work with parent groups in several public schools (Tenderloin Community Elementary, Bessie Carmichael, Redding, and Buena Vista) to improve language access and parent involvement and participation in parent-teacher conferences, ELAC, PTA, and other relavent functions.  La Voz also works on public safety campaigns to improve pedestrian safety, cleanliness and safety in children’s parks, and reduce reduce community violence. Finally, we fight for immigrant-accessible affordable housing.

The Battle of Cathedral Hill is taking shape on the site of a new hospital proposed by the California Pacific Medical Center (CPMC), Sutter Health’s affiliate in San Francisco. CPMC wants to build a 555-bed specialty hospital on the site of the former Cathedral Hill Hotel at the corner of Van Ness and Geary, in part to meet state requirements that all hospitals meet seismic safety standards by 2015. But also to consolidate Sutter Health’s regional provider network into a destination hospital, with highly specialized services that will draw patients from around the country. The development will include a new medical office building across the street from the proposed hospital.

For Sutter, this is not unique, since they have also been embroiled in controversy in other places, including Marin, San Leandro and Santa Rosa. Across Sutter’s two dozen or so affiliate hospitals in California, Sutter is consolidating hospital services, consolidating physician groups and preparing to roll out a commercial insurance product to compete with Kaiser, but with market dominance in many areas.

For CPMC, this is the culmination of an organizational vision of the controversial leadership of a hospital network consisting of four formerly independent San Francisco hospitals to construct a new hospital around highly specialized services, including organ transplants, to be recognized as one of the premiere boutique hospitals in the nation.

But what will all this mean for the health care system in San Francisco? As described in CPMC’s Institutional Master Plan, the new hospital would be a consolidation involving the proposed closure and probable sale of their California campus (the former Children’s Hospital) and the elimination of inpatient hospital services at their Pacific campus (the former Pacific Presbyterian Hospital on Sacramento and Buchanan). The Davies campus (the former Ralph K. Davies Hospital on Divisadero, in the Castro) will become a neuro-science center, with unclear consequences for other inpatient services.

One of the most controversial parts of the plan, however, is the fate of the St. Luke’s campus (the former St. Luke’s Hospital), located at the corner of Valencia and Cesar Chavez in the Mission, the only private hospital south of Market Street.

On first take, it is puzzling to understand why St. Luke’s ever became part of the CPMC/Sutter network, since it is so clearly at odds with the organizational persona of both CPMC and Sutter. As one of the last independent hospitals in San Francisco — what was once over a dozen hospitals has been concentrated into three private (Sutter, CHW and Kaiser) and two public (UCSF and SFGH) hospital systems — St. Luke’s has a long history of serving low-income people in the southeastern portion of the city, including many immigrants who have moved into surrounding neighborhoods.

As a result, St. Luke’s has lost money consistently, which is the fate of a hospital that serves high percentages of patients on Medi-Cal and Medicare, or who are uninsured. That is a stark contrast to the rest of the CPMC network, which serves a high percentage of privately insured patients that produces a very favorable bottom line. Moreover, CPMC has a notoriously bad reputation for labor relations — nurses at St. Luke’s are unionized, for example, but nurses at the Pacific campus are not — and failing to live up to their obligations as a non-profit organization to provide charity care.

So why did CPMC/Sutter take over St. Luke’s in 2001? For starters, in the late nineties St. Luke’s, when it was still struggling desperately for survival as an independent hospital, filed an antitrust lawsuit against Sutter Health, Brown & Toland medical group and CPMC for allegedly driving insured patients away from St Luke’s. The antitrust lawsuit settlement included an agreement that Sutter would maintain St Luke’s until 2005. CPMC then decided to take over St. Luke’s and keep it open through 2009, which served both as a tax write-off for charity care and a bargaining chip to get approval to build Cathedral Hill.

In addition, CPMC/Sutter was under pressure from labor unions and community health advocates for their poor record on charity care, for which St. Luke’s could partially compensate. Finally, CPMC/Sutter knew it would have to garner the political support necessary to secure the permits to construct their dream hospital at Cathedral Hill, so they were willing to absorb the losses at St. Luke’s if it helped pave the way to their larger goal.

But they also tried to minimize their losses. When CPMC/Sutter announced in 2007 that they would close acute (inpatient) care at St. Luke’s as part of their Institutional Master Plan, they were not only met with an outpouring of community opposition, but were privately informed by city officials that they would jeopardize support for the new hospital if they went ahead with their plans. In what was widely regarded as a face-saving device, CPMC/Sutter announced the formation of a high-profile Blue Ribbon Panel in 2008, ostensibly to reconsider the future of St. Luke’s.

The Blue Ribbon Panel, made up of representatives from government, private sector, labor, church and community groups (I represented the Bernal Heights Neighborhood Center), recommended that St. Luke’s remain open as a full-service hospital, and that a number of specific services be emphasized to anticipate the needs of the surrounding communities. Even though it was a public cover for some basic decisions that were made in private, many of us were willing to participate if it meant keeping St. Luke’s open. Although the CPMC/Sutter board endorsed the recommendations, it only set the stage for the next phase of the battle.

As soon as the Blue Ribbon Panel completed its recommendations, CPMC/Sutter took over the publicity. The Blue Ribbon Panel explicitly decided not to take a position on the size of a future St. Luke’s Hospital, emphasizing instead the range of services and the populations to be served. The CPMC/Sutter press release the next day, however, referred to a 60-bed hospital (since upped to 80 beds in their plans), which is not only inadequate for covering the services and populations outlined in the Blue Ribbon Panel recommendations, but probably too small to maintain its viability as an urban hospital.

Moreover, it would undermine any pretensions they had for retaining, let alone recruiting, physicians and nurses, a recurring problem at St. Luke’s. (My primary care doctor’s group practice, which is based at St. Luke’s, has lost three physicians in the last two years. And according to the California Nurses Association, nearly two-thirds of the RNs hired at St. Luke’s between 2005-2007 lasted less than two years.) To add insult to injury, CPMC/Sutter launched a PR campaign on the sides of buses and on billboards proclaiming St. Luke’s as the “southern gateway” to CPMC, as if it were some kind of turnstile to get to the real show. It became clear that CPMC/Sutter intended to get what they needed politically by keeping St. Luke’s open, but minimizing its burden on their grander plans.

Hence, the battle over Cathedral Hill. As Sarah Phelan described in her cover article in the November 24-30, 2010 issue of the San Francisco Bay Guardian (Critical Care: How the Debate Over CPMC’s Controversial Multi-Hospital Project Revived the Idea of Healthcare Planning in San Francisco), the days of healthcare planning through regional Health Systems Agencies and Certificates of Need were eclipsed in the early 1980s by the political turn to the market for the resolution of all policy issues. As the case of CPMC/Sutter and St. Luke’s illustrates, however, the market leaves key decisions up to the individual business plans of private corporations, which in this case means large, consolidated hospital networks whose primary concerns do not necessarily include such issues as equity of access. What is good for CPMC/Sutter, from their management’s point of view, might not be what is best for the health care system of San Francisco as a whole.

While there is no longer a health care planning mechanism to make that determination, there is, however, leverage in land use, an intensely local function embedded by California statute in local government. CPMC/Sutter will have to get significant exemptions from the City and County of San Francisco in order to build a 555-bed hospital and medical office building on Van Ness and Geary, where density, among other land use issues, is already controversial.

That is the context for Health Care Master Plan legislation recently introduced by Supervisor David Campos, passed by a veto-proof majority of the Board of Supervisors and returned unsigned by Mayor Newsom, allowing it to become law. The legislation requires the Department of Public Health to conduct an assessment of health care need and to develop a “determination of consistency” to advise the Planning Commission and Board of Supervisors when considering land use implications related to health care facilities.

Although the legislation will not take full force until 2013, exempting projects currently in the works, the principles embodied in the legislation can still guide the deliberations related to Cathedral Hill. This is an opportunity to demonstrate how considerations of equity of access and other implications for the health care system of San Francisco can be incorporated into land use decisions.

What concessions in zoning or infrastructure will the City and County of San Francisco be asked to make to accommodate CPMC/Sutter’s plans, and what can be required of them in return? For example, there is no compelling reason, outside of their own organizational ambitions, why CPMC/Sutter needs to build a 555-bed specialty hospital on Van Ness and Geary, and an 80-bed low-tech hospital in the Mission. The land use approval process provides a forum in which these issues can be negotiated. A smaller hospital on Van Ness and Geary, and a larger hospital in the Mission, with a better distribution of specialty services to provide more equitable access to care, would be at least one very good result of this process.

It is important, though, to understand not only the stakes, but the players. CPMC/Sutter has the big bucks, with land use attorneys, hospital planners and PR specialists working City Hall and the media, as well as trying to buy off community opposition. On the other side is the Coalition for Health Planning (which grew out of the campaign to save St. Luke’s Hospital but became a broader, citywide coalition of neighborhood, labor and other community organizations), the Good Neighbor Coalition (representing Tenderloin organizations concerned about the neighborhood effects of the Cathedral Hill campus) and Jobs With Justice.

If there is to be a meaningful negotiation over Cathedral Hill and an ability to invoke the principles underlying the Health Care Master Plan legislation, the debates cannot be conducted through the distorted influence of money and power. It is important to mobilize a grassroots base that can effectively demand a commitment to equity as an underlying principle of public policy decisions.

The Battle of Cathedral Hill is not just about a hospital. It is about how we hope everyone can live and thrive in this city, and which values will guide that vision. It cannot be only the vision that emerges from corporate boardrooms.

Members of the Community and Workers’ Rights Board
A diverse array of 200 residents, workers, and leaders gathered yesterday in San Francisco City Hall to hear testimony on the $2.3 billion hospital development plans of Sutter Health’s California Pacific Medical Center (CPMC) and the effects it would have on local access to health services. The testimony was given in front of the Community and Workers’ Rights Board which is comprised of local faith, community and elected leaders. The Board was convened by Jobs with Justice San Francisco and featured Assemblyman Tom Ammiano, Board of Education member Sandra Fewer, Sierra Club leader John Rizzo, health policy expert Laura Thomas, and Democratic Party leader Jane Morrison and was chaired by the Reverend Deborah Lee of the United Church of Christ. The Board heard testimony from patients, residents of surrounding neighborhoods, representatives from California Nurses Association and Service Employees International Union, as well as advocates for healthcare, affordable housing, and community development

Few development projects have been as controversial in recent San Francisco history as CPMC’s efforts to concentrate services to a high-rise hospital in the congested central city, while cutting services and facilities in other areas. This development undermines the interests of San Francisco patients and residents and has already led to a significant change in the way that the City assesses health projects, through the recent passage of healthcare services master planning legislation, that will require large medical facilities to justify their development plans based on public health needs.

Speaking on behalf of Southeast San Francisco’s mostly working class communities of color and the struggle to prevent CPMC from closing St. Luke’s Hospital there, Rachel Ebora of the Bernal Heights Neighborhood Center stated: “When a proposal for the closure of St. Luke’s came up several years ago – it was not surprising that our community members raised concerns for themselves and their families, and sought to unite together and fight for its continued operation. Though the community succeeded in keeping St. Luke’s open, the spectre of that closure still hangs in the air, as CPMC’s business plans expose a hospital that seems set for failure – with a reduction in services and Skilled Nursing Facilities we know is badly needed by our community members. As a non-profit hospital, CPMC’s development plans should be about equity and quality health outcomes for all people.”

Rachel Ebora-Bernal Heights Neighborhood Center and Coalition for Health Planning
Residents and advocates from the low-income neighborhoods surrounding CPMC’s proposed mega-hospital, spoke about about access to health care, jobs and affordable housing. Lorenzo Listana of the Good Neighbor Coalition stated, “as residents, we welcome development in our community, however any kind of development should be responsive to the needs of our community. Any development that is not responsive to its community is not relevant. The proposed Cathedral Hill Hospital should also address the health needs of the poor and low-income residents of our community. It isn’t clear at the moment whether CPMC will accept low-income families, Medi-Cal and Medi-Care patients.”

“We wonder if Sutter/CPMC will invest in the long-term health of this neighborhood by agreeing to strong First Source arrangements for the permanent jobs. We want a percentage of the permanent jobs. We know that the hospital will hire from all over the City and region—but they are coming to our neighborhood so we need to be hired. Without a binding agreement we fear our communities will be left out in the cold. We need to be chipped in not locked out. We don’t need charity, we need jobs and opportunities,” stated residential hotel tenant Clifton Smith of the Community Housing Organizing Project.

Over 200 people showed up to hear testimony from workers and community members
Nurses spoke about the connection between patient care, labor rights and union representation. Eileen Prendiville, a Registered Nurse at the CPMC’s California Campus, stated “I work at the California Campus. It has been 3½ years since our contract expired. CPMC from the very begin did not bargain in good faith. We are just asking for the same contract standards that nurses and other bay area hospitals have previously agreed to. It is not easy to be a patient advocate without a union to protect us. A unionized nurse is much more likely to speak up about unsafe staffing for example. Without union protection there is the very real fear of retaliation by the employer and CPMC has already targeted union activist with trivial disciplinary actions. CPMC routinely ignores our contracts, hands out anti-union information to its new nurses in the new employee package and makes every attempt to divide us.”

Board member Assemblyman Tom Ammiano said, “If it weren’t for the commitment, the dedication of the people who work there, the caregivers, the health providers, the nurses, the doctors, and the rest of the personnel, that building (St. Luke’s) would be worthless and that is what they are saying to you. They are saying that you are worthless that you are expendable well it ain’t going to happen and I promise on the state level to keep their feet to the fire.”

Remarks from Board member Laura Thomas of the Drug Policy Alliance captured the event purpose well, “I hear loud and clear concerns about housing, about accessibility of care, about jobs, and what I heard more than the concerns was the passion and the energy from the folks in this room who are determined to fight and I would be honored to be part of that fight with you.”

On behalf of the entire Board, Reverend Deborah Lee closed the hearing by offering ongoing support to the community members and workers in their efforts to resolve their concerns and demands with CPMC. Rev. Lee also stated, “the Board commits to following up on this hearing to develop a set of recommendations to be presented to CPMC and City officials early next year.”

http://missionlocal.org/2010/09/battle-for-st-lukes-sprawls-into-epic-meeting/

http://beyondchron.org/news/index.php?itemid=8514

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“Community Groups and Health Advocates Face CPMC in Planning Commission Showdown”

San Francisco community groups and health care advocates will finally get a chance to tell health care giant California Pacific Medical Center (CPMC) about the problems with their proposed Cathedral Hill mega-project at the Planning Commission’s September 23 EIR hearing. CPMC’s proposal to build fifteen and nine story buildings on the site has created an opposition coalition spanning from Bernal to Pacific Heights, including the California Nurses Association, health care advocacy groups, neighborhood residents, and local property owners. Among the issues that has gotten little attention to date is the EIR’s ignoring the project’s traffic impacts in the Uptown Tenderloin. CPMC plans turn the neighborhood’s streets into speedways, bringing thousands of cars rushing through the community each day to reach the new hospital. And while CPMC worsens the quality of life for neighborhood residents, it also plans to deny health services to most low-income people living near the planned facility.

CPMC has moved like a steamroller in crushing opposition to proposed new facilities in Alameda County and the North Bay. Now the health giant is expected to have its employees out in force at the September 23 San Francisco Planning Commission to support its Cathedral Hill mega-project.

But San Francisco may be the only city in California with the political will to contest CPMC’s agenda. This week’s hearing will be a major test, as opponents seek a project that serves the public agenda rather than simply maximizing hospital profits.

Health, Housing and Transit

While it is common for development projects to meet resistance from those concerned about health, housing or transit impacts, CPMC’s $2 billion project has aroused great concerns around all three. This has led to the formation of a number of broad opposition coalitions, including the Good Neighbor Coalition, of which the Tenderloin Housing Clinic – publisher of Beyond Chron – is a member.

It was the health issue that originally got the opposition going. CPMC’s plan poses a direct threat to the future of St. Luke’s Hospital in the Mission District, and the Bay Citizen July 29, 2010 story cited the history of the struggle and how key players like Supervisor David Campos and Assembly member Tom Ammiano are committed to saving St. Luke’s.

Today, the health care issue has intensified with concerns that CPMC’s new facility will not only largely exclude nearby Uptown Tenderloin residents, but, by taking away high end business, could soon force nearby St. Francis hospital – a key provider of health care for the poor – to close.

Many activists see CPMC as following Wal-Mart’s strategy of building new hospitals that put competitors out of business, leaving CPMC with a near and possibly complete monopoly. This is certainly the view of the California Nurses Association, whose objections to Sutter Health’s (parent of CPMC) expansion plans have led the company to say it is “disappointed” in the union.

Sutter’s monopoly would leave SF General as the only hospital serving the poor. And mean that low-income Uptown Tenderloin residents would be denied access to a hospital only blocks from their homes.

Stephen Tennis, 61, lives at the Hartland Hotel, 909 Geary Street, which is near CPMC’s project. Tennis must currently go to SF General for tests or specialized care, and considering he has no car and doesn’t always have bus fare, the trip to and from the hospital takes him all day.

Tennis is irate that CPMC’s current plans will likely deny him and most neighborhood residents’ access to the hospital: “Living four blocks from a hospital I can’t access? That’s terrible. Who do they think they are trying to do that to this neighborhood? It’s a slap in the face to the residents here.”

City Housing Requirements

A broad coalition has also emerged to ensure that CPMC contribute over $200 million in affordable housing funds as is required by the development requirements in the Van Ness Special Use District. As Malcom Yeung of Chinatown Community Development Center (CCDC) puts it, “the law requires anyone building in the Van Ness corridor to produce three square feet of residential for each foot of non‑residential. Why should CPMC be any different”?

CPMC essentially seeks to replace zoning laws with project-by-project “deals.” If the Board of Supervisors approved CPMC’s request, then no affordable housing requirements in any community would be safe.

In light of the current extreme shortage of affordable housing funds, nonprofit housing groups who have built in the project’s vicinity – including Tenderloin Neighborhood Development Corporation, CCDC, and the Community Housing Partnership – are organizing to ensure that CPMC complies with city law and pays its fair share.

Uptown Tenderloin Traffic Nightmare

In the face of efforts to improve the livability of the Uptown Tenderloin, CPMC’s project plans on routing thousands of cars each day through the residential neighborhood’s streets. The EIR estimates 10,000 trips a day, and if they come equally from four directions, the Uptown Tenderloin would have a minimum of 2500 additional cars using the neighborhood as a speedway to get to CPMC.

The EIR assumes that those coming to CPMC from Mission Bay, SOMA, or Potrero Hill will take Van Ness to reach the facility, and projects a big traffic impact at Van Ness and Market. But drivers know that the fastest route is to either go up 7th Street, which becomes Leavenworth north of Market, or up 9th, which becomes Larkin.

Most avoid driving on Market or Van Ness whenever possible. So the EIR’s assumption that the Uptown Tenderloin will be spared from massive increased traffic ignores reality.

In 2007, the San Francisco County Transportation Authority (SFCTA) released the Tenderloin-Little Saigon Neighborhood Transportation Study. The study recommended a comprehensive strategy for traffic calming and increased pedestrian safety, including corner bulbs, wider sidewalks, more lighting, and an overall more attractive streetscape (the Tenderloin Housing Clinic, which I head, led the study outreach effort, which included city staff and the Southeast Asian Community Center and Asian Neighborhood Design).

Everything necessary to implement the report, included detailed engineering plans and budgeting, was completed. But like too many traffic-calming proposals, the Study was well received but never funded.

Now CPMC wants to worsen Uptown Tenderloin traffic by putting at least 2500 more cars on its streets each day. Drivers not bringing business to the community, but simply using its streets to get to CPMC.

This is not going to happen. The people of the Uptown Tenderloin and their allies are not going to allow CPMC to turn the neighborhood into a speedway, damaging its quality of life. And CPMC will not be permitted to add insult to injury by denying health care access at the new hospital to those impacted by increased traffic.

CPMC Can Solve its Traffic Problem

CPMC can address these negative environmental impacts by funding the implementation of the Tenderloin-Little Saigon Transit Study. This will not only slow traffic through the neighborhood, but also divert traffic away by reducing the time drivers can save by using Larkin and Leavenworth Streets rather than Van Ness.

CPMC can also easily grant health services access to residents of an adjacent low-income community. Given its massive expected profits from the $2 billion project, the cost of such access will barely be noticed.

CPMC has a choice to pursue a classic “win-win” approach. But CPMC has thus far completely ignored its project’s extreme Uptown Tenderloin traffic impacts, as well as the neighborhood’s health needs.

Based on its success in other cities, CPMC may believe that it can stiff arm San Francisco city officials and politicians into caving in to a sweetheart deal. The September 23 hearing is the opposition’s chance to show otherwise.

About 120 District 6 residents gathered on Saturday August 28th to listen to District 6 Supervisor Candidates share their ideas for better health access in the Central City and beyond. We’ll be posting an analysis of their positions in a few days.