Doctors demand non-profit hospital provide benefits reflective of medical needs

August 28, 2012

POC Members Challenge Hospital Chain’s Priorities before the SF Planning Commission

At three hearings of the San Francisco Planning Commission, on 12 May, 9 June and 22 September 2011, Physicians Organizing Committee (POC) members and volunteers continued to press for responsible government bodies to demand a more equitable allocation of health resources by the California Pacific Medical Center (CPMC). The CPMC proposal for St. Luke’s, a hospital in the city’s working class Mission district, would replace the 227-bed acute care hospital with an 80-bed facility providing fewer services. CPMC is concurrently seeking the City’s permission to construct a new 555-bed hospital in the more affluent area north of Market Street, where 10 of San Francisco’s existing 12 acute care hospitals are already located. Doctors have consistently warned of the dire medical consequences of downsizing the only hospital, other than SF General, serving the southern half of the City.

POC members Eugene Gaenslen, M.D., Stanley Seifried, M.D. and Valerie Gruber, Ph.D. gave searing testimony at the 12 May hearing, lambasting CPMC’s plan in comparison to the services St. Luke’s provided in the year 2000, when Sutter first took over the hospital after the settlement of an anti-trust lawsuit involving unfair competition on Sutter’s part. They criticized the pattern of severe cuts at St. Luke’s, its impact on patient care and Sutter’s history of broken promises.
Gaenslen, a retired physician who practiced internal medicine in the area for over 35 years and has referred hundreds of patients to St. Luke’s, reminded the commissioners that Sutter/ CPMC has broken every one of its promises to adhere to the original terms under which then-Episcopal Bishop William Swing even considered affiliating St. Luke’s, formerly an Episcopal hospital, with Sutter. (See sidebar, page 9) Gaenslen then outlined the need for inpatient pediatrics, the restoration of inpatient psychiatry and other required services that CPMC has eliminated or reduced.

The commissioners were so impressed by the doctors’ testimony that President Christina Olague specifically requested that POC make a longer presentation at the start of the next special hearing on Sutter’s Long Range Development Plan (LRDP). The LRDP is, in part, CPMC’s attempt to comply with California’s rigorous seismic safety law, which requires all acute care hospitals in the state to meet strict structural standards by 2013, proving that they can remain operable following earthquakes. Several of POC’s members and various community groups such as the Coalition for Healthcare-San Francisco, regard CPMC’s pledge to rebuild St. Luke’s as an empty promise that Sutter will only keep long enough to secure the City’s permission to proceed with the Cathedral Hill project.

Gaenslen shared the 10 minute block of time allocated at the Planning Commission’s 9 June hearing with Dr. John Rouse, followed by another POC member, Emily Watters, M.D. POC members Tim Sowerby, M.D., and Dr. Gruber, who couldn’t attend due to patient care obligations, arranged for POC staff volunteers Ziad Abuni and Anna Manuel to read their statements.

Dr. Rouse, a psychiatrist who has worked for 31 years at SF General Hospital in the Psychiatric Emergency Services (PES) unit, urged the commissioners to use their authority to force CPMC to restore the psychiatric services they had cut from St. Luke’s in 2005 — in violation of the settlement agreement with the state Attorney General. Rouse noted that under the pretext of soliciting community input for a “Blue Ribbon” panel of experts to determine what was needed at the new St. Luke’s, CPMC has consistently turned a deaf ear to psychiatric needs. He explained that after POC members attended a series of “Community Outreach Task Force” meetings to advocate for a full complement of services in the new St. Luke’s, their comments about mental health services were completely absent from the minutes and were never addressed by the Blue Ribbon panel. Rouse criticized the panel’s findings as inconsistent with the testimony of doctors and representatives of patient groups on the community’s actual needs.

Gaenslen spoke about the necessity for a vibrant hospital in such a densely populated area of the city. He exposed the fallacy of CPMC’s claims of “low patient demand” justifying a radically reduced St. Luke’s. “Based on diverting services like psych, occupational medicine, oncology, pediatrics, surgery and others away from St. Luke’s to SF General or CPMC’s north of Market campuses, the census is kept artificially low. There are no fewer people living in the South of Market area than 10 years ago. They still suffer from heart attacks, GI bleeds, strokes, drug overdoses and severe asthma attacks. This plan does nothing to address the inadequate services for the poor in the southern part of the city that leaves babies born in the Bayview-Hunter’s Point area two and a half times as likely to die in their first year as babies in the rest of the city.”

Gaenslen also pointed out that CPMC’s plan not only fails to meet current needs, but provides no extra capacity to handle inevitable increases in demand ranging from earthquakes to flu epidemics, to a San Bruno-type PG&E gas explosion.
According to George Wu, M.D., a recently retired St. Luke’s hand surgeon and POC Board Member who was not able to make this hearing, “St. Luke’s cares for occupations with a high incidence of work-related injuries: cooks, landscapers, truck drivers, warehouse workers… Yet the workers’ comp contract was not renewed, the clinic doctor was laid off, and the Occupational and Hand Therapy services were closed. There’s not even a casting room for broken bones anymore.”

Sutter/CPMC’s aggressive rent hikes drive doctors out of practice or into their foundation

Within two months of the 9 June hearing, POC members with offices at the Monteagle Medical Building, attached to St. Luke’s, complained of Sutter’s renewed threats of severe rent hikes, first attempted in February. The doctors noted that the proposed increases at St. Luke’s were harsher than those for physicians at other CPMC/Sutter campuses, including a “load factor” that increased square footage by 15% for purposes of rent calculation, by including part of the hallways in front of their offices, stairwells, bathrooms and other common areas as part of their space. Sutter offered only one year leases, with no option to renew, and CPMC denied right of first refusal for office space in the replacement office building to be constructed. POC member Chung Kun Wang, D.D.S., one of only five pediatric dentists on the SF peninsula who saw children on MediCal, closed his practice in response to the hikes.

Dr. Wu and 13 other doctors in the building stated their grievances clearly in a 14 February 2011 letter to Warren Browner, the CEO of CPMC. “It seems unconscionable at this time of economic stagnation with diminished revenue for the practitioners as well as for hospital organizations alike, that Sutter Health has chosen to support their own diminished revenues with punitive increases in rent to the Monteagle Medical Building physicians in private practices… We surmise that the ultimate goal for Sutter Health is the control of the entire Monteagle Medical Building for its own foundation uses in the hopes of developing its own Accountable Care Organization with services solely determined by Sutter Health and not necessarily by the community needs.”

In August, with Sutter beginning to threaten eviction of doctors who refused the new terms, POC member Nancy Bohannon, M.D. called an emergency office meeting of POC members at the Monteagle medical building. The nine physicians and others who attended agreed the rent hikes were both a ploy to force them into Sutter’s rapidly growing medical foundation and retaliation for their effective advocacy which had prevented the closure of St. Luke’s, thus forcing Sutter/CPMC to rebuild. (See sidebar: Foundation Medical Practices, on page 10)

CPMC has also demanded that the doctors pay retroactive Consumer Price Index (CPI) inflation increases going back five years, which they were never billed for — and added “late fees.” Several physicians who complained that it was improper for Sutter to charge retroactively for something they were never billed for, received notices that they could be evicted for not paying. Another Sutter-imposed provision was a charge for holding office hours outside of a 7 A.M. to 7 P.M. schedule, claiming the extra costs of security, lighting and utilities.

Dr. Wu presented a copy of his 12 May letter to Ed Erwin, Sutter’s Director of Facility Planning Development stating, “Your demands regarding adjustment of rent already paid several years ago are preposterous and entirely unacceptable.…the notion that a non-profit institution would attempt to balance their books on the backs of providers already struggling to survive in this precarious economy astounds us. Your demands are unjustifiable and beyond the statute of limitations…”
The participants at the meeting decided to stick together in demanding that the load factor be dropped, the automatic increase be lowered from 4% to 2% per year, the retroactive CPI demands be dropped and that CPMC offer five year leases with right of first refusal for rentals in the new medical office building.

After POC Staff member Sugar Kagan reported that the $2.65 per square foot charge at the Monteagle building is above market rate and that a realtor brokered a similar deal in an adjacent medical building for $2.10 per square foot and Dr. Bohannon noted that the price for commercial real estate in the Mission had dropped 3%, the committee agreed to demand $2.10 a square foot as a fair market rate.

Dr. Bohannon then called Erwin to schedule a joint meeting to discuss their terms, insisting the doctors did not want to meet separately, but as a group.

Hostile conference room

On 15 September POC Operations Manager Brian Tseng and volunteer C.J. Teerawattanasook were invited by POC members to participate in a group meeting with Sutter Health real estate personnel and CPMC administrators. When they introduced themselves, along with everyone else at the meeting, one of the CPMC administrators, Abe Dosi, began to type into his Blackberry. Several minutes later Dosi asked Tseng to speak with him separately in the hallway. Once outside the conference room he informed Tseng that the POC volunteers would have to leave since they were neither St. Luke’s physicians nor lease holders. Tseng replied that they were there at the invitation of POC members who had the legal right to representation by their association. Dosi asked if Tseng was an attorney. Tseng responded in the negative, and reiterated that the physicians had the right to be represented by their association and returned to the meeting.

Sutter/CPMC demands
POC reps leave meeting

Dosi located a security guard, then returned to the room announcing that the meeting would have to be halted until POC’s organizers had left. Dosi was adamant despite the protests of several physicians. For the sake of motion Tseng agreed to leave. According to POC member Michael Treece, M.D., who was later ejected himself because he is not a lease-holder, but is employed in the CPMC-run pediatrics clinic in the Monteagle Building, “After they kicked POC organizers out, it was obvious that the nature of the meeting was not one where the physicians and administrators would sit down and work things out in a mutually beneficial manner, but that they wanted to get the doctors crowded into a room to bully them. So instead the doctors asserted themselves more strongly, vowing that none of them would sign a lease agreement unless they all received acceptable terms. One doctor mentioned that if Sutter/CPMC did not present more reasonable terms and continued to harm the hospital, then they would have no choice but to take the matter to the public and the SF Health and SF Planning Commissions.”

POC members called Planning Commissioner Olague and San Francisco Health Commissioner Ed Chow, M.D. Tseng reminded Chow that the rent hikes are in violation of Health Commission Resolution (HC 02-10) that CMPC had signed, agreeing to increase charity care by 79% to raise their level to that of the other private non-profit hospitals in the city. Chow expressed alarm at the prospect of physicians who practice the highest levels of charity care in CPMC’s system losing their offices and asked Tseng to bring this information to the next Health Commission hearing. Commissioner Olague encouraged POC members to speak at the Planning Commission’s next hearing.

POC exposes rent hikes to SF Health and Planning Commissions
On 20 September and 22 September, Tseng led delegations of doctors and lay volunteers to speak before the SF Health Commission and the SF Planning Commission respectively.

Health Commissioner Illig responded positively to the presentations Dr. Gaenslen gave and the statements by POC volunteers Joyce Kamps, Tony Trieu and Michael Tsukahara on behalf of Dr. Nancy Bohannon and Dr. Richard Rider. “I’d like for each commissioner to get copies of these presentations, and also to send CPMC copies and to invite them to appear before the Health Commission to answer these serious allegations,” said Illig. Health Commission President Steve Tierney emphasized the importance of making a decision based on the content of the presentation, and that it was substantial enough to warrant an agenda at an upcoming hearing.

Two days later, Planning Commission President Olague, who went on a tour of SF General’s Psych Emergency Services unit along with Commissioner Hisashi Sugaya in July, expressed her indignation at the rent hikes. In response to Dr. Rouse’s comments regarding mental health, President Olague agreed, pointing out that “psych care is an issue with greater problems than just that of Sutter Health.” Commissioner Sugaya added, “I earlier contacted Malcolm Yeung in the Mayor’s office who has been assigned to CPMC and asked him if there was anything in the Mayor’s ‘Ask’ of Sutter regarding psychiatric care and Malcolm told me ‘no, there is not.’ This rather surprised me, and I encourage everyone concerned about this to contact Malcolm in the Mayor’s office.”

Commissioner Olague stated, “Commissioner Sugaya and I went on a tour of the SF General Psych Emergency Services unit, and it was very powerful. I found out about a lot of things going on in this city that I did not even know about. The Department of Public Health should take these matters into serious consideration, and put pressure on CPMC. I am happy to raise these issues within this project proposal, but I am not exactly sure what the Planning Commission can do about them. I am interested in learning more about the rent increases on the St. Luke’s doctors.” Commissioners Kathrin Moore and Gwyneth Borden later received the same tour of SF General’s psychiatric units from Dr. Rouse (see “Mental Health Campaign” article on page 1).

After the hearing Commissioner Olague and Secretary Linda Avery remained to speak with the POC delegation about what powers the Planning Commission actually has over the healthcare aspects of the LRDP. As one commissioner had put it, “all we have the power to do is to approve the box, but not exactly what goes inside the box.”
Tseng reminded them of Health Commission resolution 02-10, in which the Health Commission put out the call for Sutter Health to increase their charity care by 79%, and emphasized the Commissions’ mandate to use its role to ensure the welfare of all San Franciscans. Commissioner Olague agreed.

Saving St. Luke’s
was just the beginning
POC’s membership has vowed to continue the struggle for an appropriately sized St. Luke’s and to set an example for the rest of the country where similar events are in motion. Dr. Treece noted that, “At the last Medical Executive Committee meeting in September where CPMC’s architects revealed the latest plans for the new St. Luke’s, there was general displeasure at the missing elements that they had promised to include. We still have a long fight ahead of us.” To find out how you to can participate in building material alternatives to such sharp practices, please call David at 415-434-9335.

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