Families Fight Closure of Nursing Unit in San Francisco

Every evening, San Francisco resident Leneta Anderson takes the 44-O'Shaughnessy bus from her home in Silver Terrace, near the Bayview, to St. Luke’s Hospital in the Mission. She eats dinner there with her husband of 59 years, Richard. He’s been living there for the past year and a half, in a skilled nursing unit that offers "sub-acute" care.

Sub-acute nursing units treat patients with complex medical needs, such as tracheostomies, sometimes for months or even years. The patients don't need as much care as a regular "acute" hospital patient, but do need a level of skilled nursing care that is difficult to provide at home. Richard, for example, has congestive heart failure and diabetes. The 83-year-old also depends on a ventilator and needs dialysis three times a week.

St. Luke's is the last hospital in San Francisco with a sub-acute unit, and parent company Sutter Health has plans to close it by the end of the year.

Anderson is worried that Richard will be transferred somewhere far away.

"I don’t want Richard to have to be transported to Los Angeles, San Jose, Sacramento," she said. "I need him in San Francisco where I can see him."

Anderson spoke at a press conference Tuesday on the steps of City Hall. She was joined by other family members opposed to the closure of the sub-acute unit.

California Pacific Medical Center (CPMC), a Sutter Health affiliate, operates St. Luke’s Hospital. To comply with earthquake building codes, CPMC is demolishing the old hospital, but the replacement building will not include a sub-acute unit. CPMC originally said residents would be transferred by Oct. 31, but more recently stated the process could go on until the end of the year.

Many of the 24 patients in the unit at St. Luke's have been there for years. Many depend on Medi-Cal for coverage, which reimburses hospitals at a lower rate than private insurance or Medicare. Opponents of the closure have speculated that CPMC is closing the sub-acute unit because of the lower reimbursements, but a spokeswoman for Sutter denied that finances were part of the decision.

Families are concerned that the move from St. Luke's to another facility will be difficult for patients, who are in medically fragile states, and for themselves, because of the cost and difficulty of traveling farther for visits.

If Richard were transferred out of the city, he would get fewer visits from family members, Leneta Anderson said: "It will kill him if he doesn't see my face or my children."

Sutter is also building a new hospital on Cathedral Hill at Van Ness Avenue and Geary Street. Representatives have said neither Cathedral Hill's hospital or the new one being built on the St. Luke's Campus will have enough space for a sub-acute unit and that they'll put together appropriate transfer plans for each affected patient and their families. But Anderson said all she's received so far is a list of hospitals where Richard might end up, and she hasn't found it helpful.

"We want to stay where we are," Anderson said, meaning she wants Richard to continue as a patient in the new hospital that will be built alongside the old building, on Cesar Chavez Street. Other relatives agree.

While the city can't stop the closure of the sub-acute unit at St. Luke's, San Francisco Supervisors Ahsha Safaí and Hillary Ronen are putting pressure on Sutter to reconsider.

"It's unfathomable, unconscionable, and essentially inhumane," Safai said. He believes moving patients out of San Francisco County would be hard on their families. "You're talking about -- quite often -- people that essentially rely on public transportation. They would literally have no way to get to see their family member in the hospital if they were shipped out of the county."

San Francisco's Health Commission, the governing body of the city's Department of Public Health, also issued a resolution condemning the closure of the sub-acute unit. In it, the commission says the closure would have a "detrimental impact on the health care services in the community."

CPMC CEO Dr. Warren Browner issued a statement saying that the health system has identified sub-acute beds in Alameda and Daly City and will work to secure those for the patients currently in St. Luke's.

Dean Fryer, a spokesman for CPMC, said hospital administrators have been discussing the closure of the sub-acute unit with the city since 2011. But families of the patients say they didn't get notified by letter until June.

The issue will be taken up next during the Board of Supervisors meeting on Sept. 12.