Neighborhoods all over San Francisco have rallied to protest the closure and rebuild of St. Luke's. Here, some teenagers from the Chinese Progressive Association rally outside the hospital in August.

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Walking down the marble hallways of City Hall on Thursday, you can hear the crowd before you see it. It is enormous, smooshed up against the carved wooden door of Room 400 like an amoeba.

Sliding into the amoeba is not easy, and neither is staying there. Waiting to get into the public comment hearing for California Pacific Medical Center’s Long-Range Development Plan Environmental Impact Review is like being inside a mosh pit of nurses, union reps and community organizers. Those who have brought stickers pass them out. There is one that reads “Stop CORPORATE GREED” and another one — enigmatic, enormous, yellow — that just says “3A+.” No one seems to know what it means.

The amoeba is here for two reasons. One: CPMC plans to build a new 15-story building at Geary and Van Ness that will centralize hospital functions currently spread across the city. Two: Part of that centralization includes plans to close down St. Luke’s Hospital at Valencia and Cesar Chavez and rebuild it as an 80-bed, rather than a 230-bed, hospital (only 150 beds are currently in use).

CPMC is an affiliate of Sutter Health, a hospital chain with a bad reputation for monopolistic behavior — the sort that has already driven up the cost of insurance premiums in San Francisco.

The door opens, revealing two panicked-looking security guards, and the struggle to get inside is on. Those with metropolitan subway elbow-poking techniques emerge at the front. The 200-plus non-victorious are shunted down to North Hall Court, to sit on folding chairs and watch the proceedings on a very large television, running upstairs to deliver their public comment when they hear their name called.

“Get ready for this to go late,” says Linda Carter. A 40-year veteran of St. Luke’s intensive care unit, she says that the last time she went to one of these meetings it was still going full-swing when she left to work a shift at 9:30 p.m.

This is politics as endurance sport. People who live around the proposed hospital site have come to complain about the increased traffic and to argue particularly with the assumption that traffic will flow up Van Ness rather than 7th and 9th streets. “The Tenderloin is home to the densest concentration of children and families west of the Mississippi,” says Erin Chen of the Good Neighbor Coalition. “As someone who has to try and cross the street with 30 ditzy five-year-olds, I’m not looking forward to increased traffic.”

Margarita Lopez, CPMC staff, comes to warn of the earthquake-related catastrophe if the new (earthquake-safe) hospital isn’t built soon. Another speaker, Jason Freed, says that an earthquake-prone city needs to have several small hospitals rather than a few large ones.

A representative of Local 38 Pipefitters Union comes to say that pipefitters and construction workers are unemployed, and would appreciate the opportunity to build a new hospital.

Mary Suricania of CPMC says that the hospital will bring 6,500 new jobs.

Hours pass. Mark Anthony of the Good Neighbor Coalition comes to say that the proposed hospital at Geary and Van Ness is not in accordance with the Van Ness Area Plan — most specifically, the part that requires that every foot of new commercial space built include three feet of residential space. James Tracy of the Community Housing Partnership says that the proposed hospital and its 1,000 new parking spaces are not in accordance with the Little Saigon Traffic Plan.

More hours pass. CPMC staff read from written statements from doctors who say they are in support of the current hospital plan. The nurses argue forcefully for exactly the opposite. The nurses sit together, a phalanx of brightly colored polyester scrubs and plastic ID badges. There are a lot of them, and when they testify it is with an intensity that is difficult for any other speaker to match.

When CPMC first began its merger with St. Luke’s, it announced plans to turn the hospital into an outpatient clinic. The nurses insist that is still the ultimate goal — one that would leave San Francisco General as the only major provider of charity care in the area.

The nurses tell stories. Linda Carter and Jane Sandoval tell of missing supplies, a decline in charity care cases taken in by the hospital, patients sent home still ill, still hooked up to IVs, and a deliberate campaign on the part of CPMC to make St. Luke’s seem unnecessary and obsolete. Reiko Furuya, a nurse in St. Luke’s critical care unit, talks about the patients in her ward, mostly uninsured charity care cases who have been shifted there after showing up in emergency rooms with advanced pneumonia or systemic shock. “Where are they going to go?” she asks, over and over. After awhile, she starts to cry.

More hours pass. Bruce Hicks, a medical transcriptionist at St. Luke’s, steps up to the podium. He explains that staff at St. Luke’s is “under a lot of pressure to come out against the nurses, and to sign statements that we approve of the plans for the hospital.

“Now, everyone wants to make their supervisor happy. But I didn’t feel like signing the cards they gave us saying that we were happy with the plans for the hospital. And so I took them when they gave them to me, and never gave them back.

“But then I was told there was a party across the hall. I was told that there would be cake and ice cream. And I like cake, and I like ice cream.”

They asked him to fill out a raffle entry before going inside, he says. He looked at the cake and ice cream inside and signed. The fine print, he found later, said he supported the plans for the new hospital.

More hours pass. It is almost 7 p.m. The overflow room is closed, and around 40 people remain — only one person out of every eight called has stayed to speak.

“The last thing anyone wants to see is a delay on this hospital,” says Jason Freed. “We need new hospitals. We want to see our brothers and sisters in the building trades putting their shovels into the dirt. But we need plan 3A.”

Here it is: the story behind the enigmatic 3A+ sticker, which almost everyone in the room is wearing, and which practically no one knows anything about.

At its core, 3A would make St. Luke’s larger and the hospital at Geary and Van Ness smaller, creating two hospitals of roughly equivalent size. “I’m going to encourage you to take it seriously,” says Freed. “Why don’t we do a full EIR around the 3A so that if the CPMC proposal doesn’t work — if the Board of Supervisors doesn’t allow it to move forward — we have a backup plan? One that the community approves of.”

The gavel goes down. “Public comment is closed at 7:07 p.m.,” says Commissioner Michael Antonini. “Comments can be submitted to the Planning Department until the close of business on October 19.”

Antonini stares out into the distance with the wistful expression of a sailor looking for a hint of dry land ahead. “I can’t help but believe that a new hospital will not improve access for people in the area,” he says. “In emergency situations, hospitals are obliged to take anyone.”

“Many people didn’t show up except for people who had been scripted to speak in a certain way,” says Commissioner Kathrin Moore. “I am sorry to be so harsh.”

President Ron Miguel is beside himself. “We have failed — this city government has failed — miserably to create a comprehensive plan addressing health care in the city. If we had, we would have a referential plan. As it is, we’re in the ocean in a rowboat without any oars. And so we’re going on instinct. Which is extremely unfortunate, and extremely annoying.”

The soothing sound of a floor buffer can be heard through the doorway of Room 400. The room is heavy with a feeling that is simultaneously fatigued and wired, like we’ve all endured some marathon together — which we have.

It’s 8 p.m. before the meeting is well and truly closed. Commissioners, nurses, PR people, friends and adversaries, all hoist their collective tote bags and disperse into the night.

More information:
Environmental Impact Review for St. Luke’s redevelopment (PDF)
EIR for entire CPMC redevelopment (PDF)

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Heather Smith covers a beat that spans health, food, and the environment, as well as shootings, stabbings, various small fires, and shouting matches at public meetings. She is a 2007 Middlebury Fellow in Environmental Journalism and a contributor to the book Infinite City.

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  1. St. Lukes is not profitable — it serves poor people. CPMC wants St. Lukes closed down so it can cater to people from the north and west of city; forget about the south — those people don’t matter. Will the city let them do this? That’s the issue and always has been.

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  2. It is good that St. Luke’s will be more of an out-patient facility. Most medical services are delivered on an out-patient basis these days. An outpatient facility will much better serve the community.

    The nurses want St. Lukes larger because it is an unionized facility — their arguments have nothing to do with patient care. It is fine for nurses and unions to lobby for things in their self-interest, but there is no reason the rest of us need to support that.

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  3. CPMC is not planning to close St-Luke’s Hospital. It’s well established that the plans are to keep the hospital open during construction.

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