Save St. Luke's Hospital

The St. Luke's Physicians' Response….

                                            To CPMC's Claims About Our Hospital

Our doctors refute these CPMC claims:

•  “St. Luke's Hospital loses $32 Million per year”

•  "60% of the beds are empty at St. Luke's"

• “85% of Emergency Department traffic is low severity”

•  “The ‘Building a Healthier San Francisco’ report supports closing St. Luke's”

• The City's Uneven Physician distribution

• "It’s a small city."

• Earthquake Safety mitigates keeping St. Luke’s open

• CPMC honors the mission of St. Luke's

Please click on claim  to see rebuttal or browse this page to see all rebuttals.

 “St. Luke's Hospital loses $32 Million per year”

 CPMC claims

1. $32 million would be better spent on providing what the community "really needs", which it claims are out-patient (ambulatory) services.
2. Closing the hospital will free up that money for developing such ambulatory services.

Rebuttal

1. The in-patient hospital portion represents only a bit over 1/3 of the $32 million.  Thus, closing it will not save $32 M per year.  The out-patient Health Care Center accounts for $10 M of the $32 M and the chronic nursing facilities (SNF and “Sub-acute” units) represent about $8 M per year in losses.
2. We agree that there is a need to develop ambulatory services, but it is a leap to then state that this means in-patient services are not needed.  The two go hand-in-hand.  In fact, if there were a stronger ambulatory base this would feed St. Luke's and make it more financially viable.
3. Moving from in-patient to out-patient services is part of Sutter's agenda since ambulatory services tend to be more profitable and we lose on in-patient services, especially MediCal.  This is really being driven by focusing on where the profit is and not by what the community really needs.

 "60% of the beds are empty at St. Luke's"

 CPMC claims

1. 60% of the beds at St. Luke's at any given time are empty.
2. This supports the conclusion that there must not be a need for in-patient services.

Rebuttal

1. The current average daily census of filled acute beds at St. Luke's is 58.  The current total number of acute beds available is 107.  The census swings as high as 75.  Thus, on average the percentage of empty beds is closer to 43% and drops to 30% during busy times.
2. The 60% figure is based on how many beds the hospital is licensed for by the State.  Most hospitals do not fully utilize all of the potential bed spaces granted by their licenses.
3. In addition to the 58 acute patients, the Skilled Nursing Facility (SNF) and Sub-acute Unit (for chronic respirator/ventilator patients) run at near capacity at 20 and 60 beds respectively.   So the total number of patients in St. Luke's on any given day is about 140 patients.

 “85% of Emergency Department traffic is low severity”

CPMC claims

1. That 85% of patients coming to the St. Luke's ED are of low acuity and could be cared for equally well in a doctor's office or urgent care.
2. If ambulatory services were further developed, such as Health First (a new service aimed at closer outpatient monitoring of patients with chronic health problems by nurse practitioners in an attempt to decrease emergency room visits), then patients would go there instead of the ED.

Rebuttal

1. At 29,000 visits per year, of which almost 5,000 arrive by ambulance, St. Luke's ED is one of the busiest in the City.  Until recently St. Luke's ED was the second busiest in the City, the busiest being SFGH.  With the closure of CPMC's California campus ED, the Pacific campus of CPMC now sees slightly more at about 32,000 per year and thus St. Luke's has moved into the position of being the third busiest.
2.  The data around the severity of the visits that CPMC is using is flawed.  It is directly from the coding done by the billing department, which has been notoriously abysmal in accurately processing St. Luke's bills.  The ED physicians use a nationally recognized coding and billing company that is the largest and most respected in the entire US for coding their services.  These professional coders rank the severity of visits as just the opposite.  In other words, 65% are of high acuity and only 20% are of urgent care or below.

 “The ‘Building a Healthier San Francisco’ report supports closing St. Luke's”

 CPMC claims

1. CPMC makes references to two sentences in the report which state that ambulatory services are needed in San Francisco, and that many admissions to hospitals are avoidable if patients received adequate ambulatory care.
2. Based on these two sentences, taken out of context from a voluminous report, CPMC asserts that this supports closing in-patient services south of Market.

Rebuttal

1.     We agree that the entire City, especially SOMA neighborhoods will benefit from better access to ambulatory services.  However, it is an error to then assume that this means that in-patient services are not also needed.  The report did not draw that conclusion, it is being inferred by CPMC

2.     Stats on admission diagnoses at any hospital demonstrate that even in a neighborhood with excellent ambulatory access, hospital admissions for congestive heart failure (CHF), asthma, diabetes, infections etc still comprise a significant percentage of admissions - and for patients in our socio-economic bracket this is even more pronounced. The report's statement that many hospitalizations could be avoided if better ambulatory services existed is a generic statement that is true for the entire US and reflects the fact that we are in a national crisis of declining primary care with increasing difficulty for patients to make appointments to see doctors. Acute care is critical to a health plan for SOMA. 

 3.     San Francisco has been cited recently for being 100 hospital beds shy of Federal standards for "surge capacity" which

would be needed to respond to a large scale disaster.  Closing St. Luke's will widen that gap by doubling it.

4.     While this issue should be addressed by developing better ambulatory services, it makes no sense to eliminate the safety net that many patients rely on until other solutions are in place and proven.  Health First is a pilot project that is "hoped" to achieve this goal but not proven.

5.     The named sites for the three ambulatory centers planned for construction are all in areas chosen for their high concentration of health insurance and not based on providing access to persons in the community that currently use St. Luke's as a medical home.

The City's Uneven Physician distribution

 CPMC claims

1. The primary care and specialist physicians are unevenly distributed with the majority being NOMA, thus the underserved do not have access to physicians.
2. Building 3 ambulatory centers SOMA will solve this problem and improve ambulatory care access that is needed for the underserved community.

Rebuttal

1. The maldistribution is a function of 2 things.  First, payer mix in those communities and second, doctors locate their practices near hospitals.  The physicians in NOMA are clustered around the hospitals in NOMA. Since there are more hospitals NOMA there are more docs in NOMA.  Closing the only private hospital in SOMA will worsen the maldistribution, not correct it.
2. The 3 sites chosen in SOMA for the proposed ambulatory clinics are based on high payer mix and not serving the underserved.  Specifically, these three zip codes have been identified as having a high proportion of "good insurance". 

"It’s a small city."

CPMC claims

1. San Francisco has a 750,000 population and states “You can throw a baseball from one side to the other”.   They point out that 40% of the population lives in SOMA.
2. We don’t need to have hospital care in such a small city in every neighborhood, it is better to have good access to primary and specialty doctors.

Rebuttal

1.     While the city is small physically, ambulance driving time is much more affected by street layout and congestion, especially in crossing Market. It takes an inordinate length of time to get to CPMC's California campus from SOMA and this will be a problem for women actively in labor, ambulances, etc. This demonstrates that an entire section of the city’s citizens will be effectively left without access to CPMC hospital services.

2.     A stand-alone ED is an unlikely proposition.  Only two exist now in California and the State clearly does not want to give such a license again, especially to an urban facility.  Also, it is the opinion of the St. Luke's ED staff that this would not work, especially in light of the existing unwillingness on the part of CPMC physicians to accept patients in transfer from St. Luke's (i.e. Medi-Cal/uninsured patients).

3.     We agree that every neighborhood does not need its own hospital, but what about the southern half of the entire City?  Will SFGH, which is already congested and frequently on divert be enough?  We must think about what it would mean for patients having heart attacks, GI bleeds, strokes, drug overdoses or severe asthma attacks, let alone patients in cardiac arrest.

 Earthquake Safety mitigates keeping St. Luke’s open

 CPMC claims

1. It is better to build one new hospital than retrofit three (St, Luke’s Hospital, Pacific and California campuses).
2. SLH has liquefaction risk under the tower at northeast and south ends.

Rebuttal

1. We have no objection whatsoever to the building of the Cathedral Hill Hospital. But we believe that the SOMA area of the City, where the greatest disease burden exists and greatest need exists, cannot afford to lose one of only two acute care hospitals, while seven acute care hospitals are currently NOMA.
2. The liquefaction earth quake risk will be mitigated by a $3 million project, already approved by CPMC Board.  This means that SLH could stay open until the retrofit deadline in 2015. But, we believe firmly that St. Luke’s is a viable institution and should remain open indefinitely so as to allow for its revitalization.  

 CPMC honors the mission of St. Luke's

 CPMC claims

1.     CPMC claims to "know" what the people of the south of Market neighborhoods really need.  This is largely based on the Building a Healthier San Francisco report.

2.     CPMC has offered a new interpretation of the St. Luke's mission, broadening it to refer to health care generally and not specific to its function as a hospital.

Rebuttal

1.     CPMC was forced, as a consequence of a settlement of an anti-trust law suit, to accept St. Luke's into it's "family".  There still exists a great deal of unwillingness on the part of many of CPMC physicians to accept the St. Luke's clientele of patients.  Notable exceptions to this include the pulmonologists, cardiologists, and gastroenterologists, who have for the large part been very supportive of St. Luke's Hospital and its mission.

2.     St. Luke's was founded 135 years ago as a hospital.  Its mission statement is that of serving the community as a hospital.  At the direction of Sutter, the mission statement was rewritten to its more generic form that downplays its hospital role.

3.     In light of the fact that St. Luke's is only one of two hospitals south of Market, which by any interpretation is a dramatic dividing line across this City, we must ask ourselves the question, "Is rewriting or reinterpreting the St. Luke's mission statement the same as honoring it?"
 

 The Founding Mission Statement of St. Luke’s Hospital

 "St. Luke's doors are open wide for the reception of all colors, nationalities and creeds. Its benefits, refused to none, will be limited only by its means."

                1871, Episcopal priest and physician The Rev. Dr. Thomas Brotherton, Founder

                                      Rector, St. John the Evangelist Episcopal Church, 15^th and Julian

We believe that the “means” are within reach, and that with sufficient will, and collective commitment, we can, and must find a way to preserve and revitalize this much needed institution.  

 From the CPMC Public Affairs Fact Sheet on the future of St. Luke’s Hospital…

                        ….. Quality Care – A Right, Not a Privilege

                                                                    We couldn’t agree more!!!