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A physician at St. Luke’s
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Statement of
Kenneth Barnes, M.D. before the San Francisco Health Commission, November 13,
2007
My name is Ken
Barnes. I am a physician at St. Luke’s, having been practicing there for over
27 years. Prior to that I was the co-founder of the Family Practice Residency
Program at San Francisco General Hospital and taught on the faculty of that
program, and continue to teach at UCSF.
I am going to talk
about past efforts to revitalize St. Luke’s after the affiliation with Sutter.
I have a unique perspective, in that I was hired by Jack Fries, the former CEO
of St. Luke’s, after the affiliation to help him rebuild St. Luke’s. I was in
the position of Physician Advisor to the CEO for 3 and ½ years from 2002-2005,
first with Mr. Fries, then with John Williams who succeeded him.
- Physician
development: Martin Brotman came before you as a body on November 15, 2005
and said that there is a timeline for a three year revitalization program.
The major thrust of the solution to St. Luke’s is on the revenue side, and
that means improving the attractiveness of St. Luke’s to doctors and
patients. His approach was to work in collaboration with key stakeholders
to revitalize St. Luke’s. He said physicians must come to St. Luke’s in
order for the recovery to work. Let’s look at what actually happened. There
was a physician development plan in 2004 to transition St. Luke’s Hospital
Health Care Center physicians into a medical foundation. Part of this plan
was to align SLH services to the underserved with a local Federally
Qualified Health Center, allowing greater reimbursement. Finally, there was
a plan to develop a community physician network to align clinical care and
coverage in the SLH local market. None of this happened, but they are still
good ideas. Part of these efforts was eventually incorporated into Project
Turning Point, a revitalization project, but this lasted about 1 year and
gradually died.
- Physician
Recruitment: I headed this for three years. We recruited a number of
primary care physicians when Sutter deemed the area surrounding St. Luke’s
as an underserved area. But they then did another study which said it was
not an underserved area, and stopped giving financial help to practices
recruiting primary physicians. This is NOT a good growth strategy. In
addition, there are a number of physicians in the St. Luke’s neighborhood
who do not admit there. Efforts should be made to give them reason to admit
their patients to St. Luke’s. Finally, several specialties are
underrepresented at St. Luke’s and need to be recruited. Efforts at this
were attempted during my time in administration, and do not appear to be
ongoing under CPMC.
- Physician
Retention: I developed a Physician Liaison Program, where various
administrators, including physicians in administrative positions, were to
call current physicians on a regular basis, asking if they had any
concerns/problems/issues and could we help them. We were to do this on a
regular basis. This lasted about 4-6 months, and stopped due to lack of
support.
- Service line
development and Clinical Integration of Services: there were efforts at
clinical development that included working with CPMC. These began in early
2004. Several service lines were identified that could be further developed
and possibly integrated with CPMC. These included:
- Women’s
and Children’s: our Obstetrics Department did grow and delivers upward
of 1200 babies per year. We did develop a Breast Center, and recruited
a breast surgeon as well as dedicated mammographer. However, little
integration with CPMC occurred.
-
Cardiology: this is the most developed program, with significant
integration with CPMC. We have a catheterization laboratory, well
equipped outpatient non-invasive diagnostic services, cardiologists from
St. Luke’s and CPMC, cardiology fellows from CPMC training at St.
Luke’s, and a Cardiovascular Risk Reduction Program for high risk
patients. This is an example of what CAN be done.
- Oncology:
we did hire an oncologist, but he was not able to develop our program.
There were several tries at getting oncology practices at CPMC to come
to SLH, but these did not work. Oncology remains an opportunity.
- Surgery:
there were several efforts to build up surgery, spearheaded by surgeons
and anesthesiologists at SLH. Plans and protocols were developed,
equipment replaced, recruiting of surgeons done, and for a while things
were better. A smattering of CPMC surgeons came for a short time, but
this didn’t last. When CPMC management came, there was a perception of
condescension on their part, several key operating room personnel left,
enthusiasm waned, and morale is apparently low.
- Barriatric
Surgery: weight loss surgery was seen as an opportunity, and a surgeon
from CPMC was recruited, equipment was purchased. However, for various
reasons, this fizzled. The equipment, I believe, lies dormant.
- Nursing: there
were many complaints from physicians about nursing. We then undertook a
systematic evaluation of nursing, identified areas that needed correction,
and with strong nursing leadership, instituted educational efforts,
including interdisciplinary rounds on a daily basis. These ended when the
nurse driving this found herself not receiving adequate support. This
occurred at the time of greater involvement of CPMC at the hospital.
- Emergency
Room: Martin Brotman stood before you on November 15, 2005, and said there
will be an immediate investment of $30 million for a new Emergency Room.
This never happened. Our ER desperately needs remodeling, especially as a
sign of respect for our patients.
- Psychiatry
Services: we used to have significant outpatient psychiatric services, as
well as an inpatient psychiatric floor. These were closed when we and
others knew there was a great need for these services. We need to bring
back services such as this that were cut.
- Repatriation
of Patients: we started 4 years ago to work with administration, and want to
again, in identifying patients from the St. Luke’s area who were admitted to
other campuses of CPMC. We need to determine the reasons why they were not
admitted to St. Luke’s, and work with administration to address these
issues.
- Quality of
Care: St. Luke’s was just recertified by the Joint Commission on the
Accreditation of Health Care Organizations, receiving high grades. Its
Women’s Program has been recognized Sutter-wide as providing the highest
quality care, and our Cardiac services are among the top in the United
States in terms of treating heart attacks and congestive heart failure. We
need to be recognized for our quality and be given the opportunity to
enhance that quality.
- Marketing:
there were a number of marketing efforts that included collaboration with
CPMC. These included the Women’s Program, Cardiovascular Risk Reduction
Program, Pulmonary Education Program, and St. Luke’s in general, among
others. Most recently there was the “Rediscover St. Luke’s” campaign.
Hundreds of thousands of dollars were allocated by CPMC to put large posters
of physicians and other hospital workers in BART, on buses, and around the
hospital. Five TV spots were made at the end of last year, but they were
never shown. This was just before CPMC announced that they were closing St.
Luke’s. One of the reasons I have learned is that the videos referred to
St. Luke’s as a HOSPITAL, which was not in CPMC’s plans for St. Luke’s.
- Institutional
Master Plan: in 2002-3, there were serious plans developed by Sutter
regarding the building of a new St. Luke’s as well as a new physician office
building. These plans died a gradual death, as Sutter realized it wanted to
get St. Luke’s off its books and transfer it to CPMC. Talk of rebuilding
St. Luke’s has never been on the table with CPMC.
I ask you: WHY
CAN’T THESE PLANS INVOLVING PHYSICIAN DEVELOPMENT, RECRUITMENT AND RETENTION BE
REINSTITUTED? WHY CAN’T SERVICE LINE DEVELOPMENT AND CLINICAL INTEGRATION
CONTINUE? WHY CAN’T NURSING DEVELOPMENT ALONG THE LINES PREVIOUSLY STARTED AND
SEEN TO BE SUCCEEDING BE RESTARTED? WHY CAN’T MARKETING EFFORTS BE REVITALIZED?
WHY CAN’T THE ER BE REBUILT AND PSYCHIATRY BE BROUGHT BACK? WHY CAN’T CPMC MAKE
CATHEDRAL HILL A BIT SMALLER AND BUILD A 100-125 BED NEW ST. LUKE’S TO SERVE THE
SOUTH OF MARKET AREA?
WE BELIEVE THIS
REVITALIZATION IS POSSIBLE AND ABSOLUTELY NECESSARY. OUR COMMUNITY OF PATIENTS
AND THE PEOPLE OF SAN FRANCISCO DESERVE NO LESS.
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