Photo courtesy of D. Sharon Pruitt.

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It was scheduled for 2:30 p.m., but an hour and a half later the issue of whether to develop a citywide health care services plan still isn’t up on the agenda. The usual suspects wander around outside — Kevin McCormack, public relations for California Pacific Medical Center (CPMC), Nato Green, public relations for the California Nurses Association, and the clot of gangly teenagers from the Chinese Progressive Association, who get shooed away from the wedding in progress at the top of City Hall’s stairs by a minister in a white scarf.

The health care master plan’s origins lie in confusion — most particularly confusion around the contentious battle over the plans developed by California Pacific Medical Center to build a 15-story hospital on the site of an old hotel on Cathedral Hill in the Tenderloin, while simultaneously reducing the number of total hospital beds at St. Luke’s in the Mission.

Was it true — as the Chinese Progressive Association said — that St. Luke’s needed to be kept at current capacity or have its capacity increased in order to meet the needs of the Mission, Bayview and Excelsior ? At present, the latter have only SF General and St. Luke’s as options. Was it true that a 15-story hospital in Cathedral Hill would save lives (by providing a centralized location for specialists and equipment), or hasten their end (by centralizing to such an extent that patients who could have been treated in a smaller neighborhood hospital like St. Luke’s would die in traffic before ever reaching treatment?). Which type of hospital will we wish we had built when the next big earthquake comes?

“We have failed — this city government has failed — miserably to create a comprehensive plan addressing health care in the city,” said Planning Commission President Ron Miguel at the public comment hearing for the environmental impact review of California Pacific’s plans, which sprawled into a six-hour struggle between a group that included, but was not limited to: California Pacific, the California Nurses Association, the Local 38 Pipefitters Union, the SEIU, the Good Neighbor Coalition and the Community Housing Partnership.

“We’re in the ocean in a rowboat without any oars,” Miguel continued. “And so we’re going on instinct. Which is extremely unfortunate, and extremely annoying.”

The master plan as it is currently envisioned would take about a year to write — a joint construction of the Department of Public Health, the Planning Department, various healthcare providers in the city and various community organizations. It would kick into effect for any proposal for a health care building over 10,000 square feet. Though its decisions could be overruled by the Board of Supervisors, those decisions would have actual regulatory power.

Le Tim Ly, a community organizer with the Chinese Progressive Assoociation, said this health care master plan, if it is developed, will be more important than the individual fights to keep St. Luke’s Hospital open and running at its current 229-bed capacity; more important than keeping local hospitals from cutting the amount of charity care they deliver.

The plan is important because there is money in the wind — borne toward San Francisco on the slow-moving wings of the federal health care plan. A master plan delineating which neighborhoods need better health care would almost certainly send that money in the direction of the southeastern neighborhoods that Ly agitates on behalf of.

The barrier to anyone actually talking about the plan anytime soon is the North Beach library agenda item.

It finally comes up at 5:15 p.m. — nearly three hours later than expected and 18 minutes after the first pitch of tonight’s World Series game has been thrown.

“It’s 0-0,” a man in the room announces to no one in particular. Audible sighs of relief are heard.

“I know we all have a game to watch,” says David Campos. “So I’ll be brief. This enables us to do what we were elected to do — make sure that all San Franciscans have equitable access to healthcare.”

For example, Campos says, the city needs primary care physicians in every neighborhood, so a building that would provide offices for primary care would speed through the building permit process more quickly than a building that doesn’t. And with that, it’s time for public comment.

The teenagers are allowed to go first, because it’s a school night. Hearteningly, the teenagers’ oratorical skills are improving. Local politics is often a numbers game — a matter of putting as many human bodies in front of the public comment microphone as possible — and the teenagers are those bodies.

Earlier in the summer, the teenagers would deliver virtually identical speeches made up of virtually identical catchphrases in virtually identical monotones. Now they’ve begun to improvise a little. A few of them tell stories — family languishing in emergency rooms, family whose treatment is complicated by a lack of medical interpreters. The boredom of listening to the more robotic ones work their way through their talking points is tempered by watching them progress, slowly but surely, in the art of public speaking.

After the teenagers are finished, the grownups take over — public relations people and community organizers in favor of the master plan, and public relations people from Kaiser Permanente and the San Francisco Chamber of Commerce and Catholic Healthcare West who don’t necessarily come out against the plan, but who universally ask for an indeterminate period of time to continue negotiating.

“I admire what Kaiser is doing,” says Sophie Maxwell to Randy Wittorp, director of public affairs for Kaiser, after he argues that a master plan could drive healthcare out of San Francisco entirely. “You are not a hospital that can’t. You’re a hospital that can. Have you figured out a way that we can do this? You all plan for years and years. As a city, we need to do the same thing. Without planning, there’s chaos.”

“What we need is more time,” says Wittorp.

“I understand,” says Maxwell. “But if we do a planning process, if we have a plan, it is clearer. As a city we have a responsibility to figure out how to bring the best health care to anyone in our city.”

“We see the need for planning,” says Wittorp.

“We don’t have a lot of time,” says Maxwell.

“It took 18 months to come up with the health care plan in Washington for a reason,” says the public relations woman next to Wittorp. “Our health department is used to planning for 20 percent of the population, not 80 percent.”

“We’ve been talking to this industry for at least six months,” says Campos. “At a certain point, we need to fish or cut bait.”

“The Planning Department passed this one to five,” says Maxwell. “This is clearly something they think we need.”

“We are concerned,” says the woman with Wittorp, “that this will drive up costs at a time that we are being asked to drive down costs. You don’t understand what we have to go through with the Office of Statewide Planning process in California.”

“I understand,” says Maxwell, “but that’s why planning in itself serves to cut costs. Why do you think CPMC has been out so long? If we had had something in place, they would have understood the importance of St Luke’s. Planning is one of the most important things you can do.“

“I think that is what is happening here,” says Campos, “is that there are people who genuinely believe that the city should not have a role in planning the future of health care.”

Campos and Mar want to vote that night. Maxwell wants to postpone the vote for a week, to give the health care representatives time to come up with “seven or ten” specific suggestions as to what they want to see in the plan. Chiu wants to postpone the vote, but just for a week.

“When you have an industry that has had six to seven months, it’s hard to see how two weeks is going to make a difference,” says Campos. “The reason the Health Commission has not acted — it’s because the hospitals have been lobbying. It’s like what Ammiano said — if the industry had their choice we would have no Healthy SF. I think we should vote today.”

“Well Supervisor Chiu and I are not ready,” says Maxwell. She calls the vote: two ayes and one no. The vote is postponed until November 15.

“Giants!” a voice in the room yells. “Three up!”

The room breaks out into joyful shouts. Briefcases are clutched. Handbags are hoisted. And just like that, everyone is gone.

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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 Comment

  1. Couldn’t you hear the crowd outside? Must have been totally surreal coming out of that scene into the plaza.

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