Families, doctors plead to keep S.F.’s only sub-acute facility open

Patient family and advocates at a protest ahead of Tuesday's Health Commission meeting. Photo by Laura Wenus

Nurses, advocates and family members of patients at the St. Luke’s Hospital skilled nursing and sub-acute units delivered hours of testimony to the Health Commission Tuesday, prompting the commission to ask the hospital’s operator to try harder to keep patients in San Francisco.

“If my son has to leave St. Luke’s, he’s not going to live too long,” said one woman, whose son is dependent on a ventilator and has stayed at St. Luke’s for years. “I’m begging you, please keep St. Luke’s open. … Since I got his relocation packet in the mail, I’ve been numb.”

Skilled nursing facilities care for patients that need round-the-clock medical attention. Sub-acute beds in such facilities are designed for patients who are more medically fragile, need a ventilator or intravenous feeding, or are recovering from a condition that needs acute attention. 

St. Luke’s sub-acute unit is scheduled to close October 31, which would leave no such units left in the city. That, said one doctor, will have dire consequences.

“These patients cannot be transferred. They will die, plain and simple,” said Dr. Gary Birnbaum, the medical director of the sub-acute unit. “Sub-acute patients are not like [skilled nursing facility] patients. They are one step below the ICU, and they need to be near an ICU.”

The hospital’s operator, CPMC, says it is working diligently to safely relocate all the patients to other facilities that can properly care for them.

Those who have family members in the unit — about 29 of the 79 beds in the unit remain occupied, according to a Health Department memo — came to Tuesday’s hearing to express horror at the idea that their loved ones would need to move. Many were concerned that they would no longer be able to regularly visit their loved ones once they’re moved out of the county.

Marshia Pushia’s mother is at the St. Luke’s facility, and is dependent on a ventilator, among other things. “She has excellent care,” Pushia said. “All I ask is that you put yourself in the family’s shoes … please help us.”

The hearing was prompted by a 1988 voter resolution, Proposition Q, which requires the commission to study whether the closure of a local medical facility will harm public health.

Commission President Edward Chow said at the beginning of the hearing that the Commission can’t stop the operator of St. Luke’s, California Pacific Medical Center, from closing the unit.

“We have no authority to halt any actions on the part of the facility, but do hope that with the public’s interest and advice in a public hearing that the facilities and public and ourselves could all work together to try and resolve some of the issues that may rise,” Chow said.

Commissioners critiqued CPMC owner Sutter Health’s decision to close the unit, and asked CPMC officials pointed questions.

California Pacific Medical Foundation CEO Dr. Warren Browner told the commission that the closure had long been planned as part of the transition from the old St. Luke’s building to a new campus being built nearby. 

The new hospital is scheduled to be completed in mid-2018; the hospital’s top priority is to get staff ready to transition and be able to provide acute care, Browner said.

“We don’t have room in our other facility to accommodate sub-acute beds and the acute patients who we take care of every day. I wish it was otherwise,” Browner said.

For years it’s been public knowledge that the facility would close, Browner argued. CPMC’s renovation of St. Luke’s hospital is part of a deal the health nonprofit worked out with the city as it sought permits for a 270-bed facility under construction on Van Ness Avenue and Geary Boulevard.

A first version of the agreement, Browner said, would have required CPMC to keep 100 skilled nursing beds in operation in the city at all times. Once it had been worked over by the Board of Supervisors, he said, that requirement was removed.

The agreement also limited the size of the new hospital, which was originally slated to have 550 beds. With a bigger facility, Browner argued, Sutter might have had room to accommodate skilled nursing beds. Now, there’s nowhere to put patients who need sub-acute care, and limited space for patients who need skilled nursing. So, many will have to move to facilities outside the county.

“The Department of Public Health has reviewed every step of our notification process and confirmed that we are in compliance,” Browner said.

Health commissioners asked the company to find some way to improve its communication with patients and consider alternatives — including, if possible, delaying closure of the facility.

“It concerns me that we don’t have a plan,” said Commission Vice President David Pating. “Otherwise, we are a sinking ship without a lifeboat.”

More than one commissioner emphasized the need for cultural competency. Patient advocates have previously claimed that the documents announcing the facility’s closure had been distributed in English only. In one case, they had been handed to a developmentally disabled woman unable to understand them.

Commissioner James Loyce, Jr. was the first to point out the demographics of the community members who had come to oppose the closure.

“What we saw in the community speaking today was largely people of color,” he said.

The Commission is scheduled to hold another hearing Sept. 9.

This story has been updated to reflect occupancy numbers from a DPH memo to the Health Commission indicating that 29, not 22, of the 79 beds in the unit are still occupied.

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