The San Francisco Health Commission decided Tuesday night that the closure of a skilled nursing facility at St. Luke’s hospital in the Mission District “will have a detrimental impact on the health care services in the community.”
At the second of two hearings on the matter, Commissioner David J. Sanchez Jr. called St. Luke’s Hospital “the last standing pillar of excellence,” and added, “hopefully that will not be dismantled.”
Warren Browner, the CEO of California Pacific Medical Foundation, which runs St. Luke’s, said hospital administrators have formally petitioned the state Department of Public Health to allow a delay in the facility’s closure, scheduled for Oct. 31, to the end of this year. It’s unclear how long the state will take to grant or block that request.
“We initially chose the most conservative targeted closure date — Oct. 31, 2017 — to ensure that we’d have sufficient time to work with each family and place each patient in a facility that can accommodate their specialized needs well in advance of the move to the new Mission Bernal hospital in mid-2018,” Browner said in prepared remarks.
The skilled nursing facility will not be transferred to the new hospital because there’s no room for non-acute beds, Browner said. A 2013 deal with the city reduced the size of the Van Ness hospital. Looking ahead, the total number of beds in CPMC’s system will decrease from 932 to 534 by 2019, Browner told the Commission.
Most of the alarm from the public has come with regard to one particular floor of the skilled nursing facility, which houses sub-acute patients, a more medically fragile group. Many of the 24 patients who remain in that facility’s 40 beds have been there for years, some even decades. They have been struggling to find a suitable facility nearby.
Commissioners also recommended that the facility remain open until suitable relocation plans be secured for all of the patients remaining at the facility.
The language of the resolution does not specify, however, that the new beds be in the city and county of San Francisco — something that patients and their advocates have long considered crucial.
They again came to the commission on Tuesday night with hours of public testimony, pleading for the unit to stay open. Most fear that moving their families far away would be harmful.
Closing the center now and relocating the patients, said nurse Jane Sandoval, would “disrupt the therapeutic environment that the nurses have created.”
After a recent meeting with hospital administrators, Rick Vallejo, a family member, told the commission, he felt defeated and out of options. His sister has been at the sub-acute facility for about six years, and with nowhere close by to take her, he felt his only option was to take her home — but that would provide her with inadequate medical treatment. Taking her elsewhere would leave her separated from friends and family.
“The only two options I have are death and death,” he said. “I felt insulted, and my hope was shot.”
Browner told the commission that California Pacific Medical Center had been working diligently to find accommodations, and was hoping to secure some placements in Alameda shortly.
But in some cases, distance is not the only issue. Some patient families say they have been offered placement in San Jose, but will not accept it because of the distance and fears about subpar care.
Raquel Rivera, whose sister has been living at the sub-acute unit for seven years, relayed a story from a former sub-acute patient at St. Luke’s who had been relocated to a unit in San Jose and was frustrated with the kind of breathing equipment he was given there.
“He said now he is waiting to die,” she said. “Here’s an example of transfer trauma.”
She and other patients have been pushing legislators and city bodies to hasten the development of a solution that would create or retain sub-acute facilities in San Francisco.
So far, nothing concrete seems to have presented itself, though efforts are ongoing.
David Serrano Sewell, regional vice president of the Hospital Council of Northern and Central California, told commissioners that the Post Acute Care Collaborative had sent the commission a letter outlining its most recent efforts to find an answer to the lack of local sub-acute beds. The collaborative is tasked with studying and solving the problem of dwindling long-term care beds and disappearing sub-acute care.
Commissioner James Loyce, Jr., was unimpressed with what had been submitted, saying the letter “by no means answered the questions raised at the last meeting,” and stressed his earlier instruction that healthcare administrators look specifically at the needs of minorities.
“I’m greatly concerned about people of color being represented,” he said. “I think you can do better. I think you will do better.”
The Health Commission does not have any authority to compel the health nonprofit to take action. Other bodies are considering further hearings on the matter, however — the San Francisco Board of Supervisors may consider the issue again, either in committee or as a committee of the whole.