Nena Farrell

All backed up

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In February 2004, San Francisco saw an usually strong winter storm. More than an inch and a half of rain fell within 30 minutes, too much to handle for the wastewater system, which in parts of the city is more than 100 years old. In the Mission and Bayview, some homes were flooded with rainwater and raw sewage.

Before adjourning for the year, the Board of Supervisors on Dec. 13 approved payments settling a lawsuit filed in January 2005 by some of the residents affected by the storm. The main plaintiffs in the case were Jane Martin and David Baker, whose home in the Mission district were flooded.

More than 40 individuals and businesses joined the lawsuit as plaintiffs, with San Francisco and its San Francisco Public Utilities Commission (PUC) as the sole defendant in the case. The plaintiffs sued for dangerous conditions of public property, failure to maintain public property, negligence, nuisance, and the trespass of water and sewage onto the plaintiff’s properties.

The settlement totaled $624,930 in compensation for property damage, including $50,000 for Martin and Baker, and many of the other plaintiffs getting around $25,000 each.

“Simply put, the city wasn’t doing proactive maintenance,” Baker told us.

Representatives of the SFPUC are trying to change that. There are currently several projects in the works to address issues with the city’s sewers, including flooding. These include Model Block improvement programs, such as green streetscaping meant to soak up rainfall, and a Sewer System Improvement Program that is in its early stages.

According to SFPUC spokesperson Jean Walsh, the SSIP is meant to tackle a number of issues with the sewer system, including flooding. She listed “seismic reliability issues” and a projected increase in major storms due to climate change as pressing reasons for the plan.

Besides the ancient pipes, the city’s network of storage transport boxes is routinely overloaded. These boxes are underground containers that catch water and hold it until it can be processed through the system and through to water treatment plants. Walsh says that they “surround the city like a moat… When those boxes fill up and all our capacity is full, the system overflows.”

This can cause flooding, especially in low-lying areas of the city and natural creek beds. Precita Creek, which once flowed freely along what is now Cesar Chavez Street, has been a site of overflows and flooding since it was first incorporated into the city’s sewer system in 1878. Nearby Islais Creek has also been diverted into sewers in the flooding-prone area.

The SSIP will have a particular focus on green technology. “One way that we’re going to address the flooding issue is by using low-impact design,” Walsh said. “We’re looking at permeable paving, bio-retention swales, and rainwater harvesting as ways to reuse the rainwater.”

Walsh says that the Model Block program has been a pilot for the SSIP. In May, the city and the Environmental Protective Agency unveiled a new green “streetscape,” part of the Model Block program, on the 1700 block of Newcomb Avenue. Areas of the sidewalk were replaced with permeable pavement, trees and gardens, meant to improve beauty and calm traffic as well as soak up rainwater so that it does not flow directly into the sewer system. In 2010, a similar project was completed on Leland Avenue between Bayshore Boulevard and Cora Street.

Neighborhoods in San Francisco’s southeast, particularly the Mission and Bayview, have been disproportionately affected by problems with the sewer system. Olin Webb, a lifelong Bayview resident and member of the group Bayview Hunters Point Community Advocates, says that sewer improvements are long overdue.

“Whenever it storms, there’s an overflow here,” Webb said. “Every time it rains, you can smell the raw sewage.”

Bayview community organizations have been campaigning for improvement to the sewer system for decades. Webb said some progress has been made in the past few years, including the installation of a pathway at Yosemite Slough Park, part of an effort to restore the wetlands in the area and turn it into a pleasant community space.

Webb was ambivalent about recent improvements. Bayview Hunters Point, like most of San Francisco, has lost much of its African American population during a recent surge in out-migration. According to a 2010 census, San Francisco’s black population has declined by 22.6 percent in the last decade.

“This took too long,” Webb said of the sewer improvement. “I’ve been here 60-something years, my mother worked on this before me. It’s like a joke to me that now everything’s getting fixed up and most of the people can’t enjoy it.”

Residents may still have a to wait for SSIP projects to begin construction. The program will likely span 15-20 years, and is currently in its early stages. “The project is still in design and planning stages,” Walsh said. “It needs to be validated and budgeted. We know it’s going to cost multiple billions of dollars”

Yet Walsh is optimistic that the project will make real change in a sewer system that’s been inadequate for decades. “It’s going to be an impactful project,” she said. “People are going to notice it happening.”

Lack of charity

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Activists and city officials are challenging California Pacific Medical Center — which a new study shows provides far less charity care than other San Francisco hospitals — to do more for all city residents if it wants approval for the massive new high-end hospital and housing project it is seeking to build on Cathedral Hill.

That $2.2 billion project, which the city will consider sometime next year, would also rebuild or modify four other CPMC hospitals in town, including St. Luke’s Hospital, which serves low-income Mission District residents, but which will see its number of beds cuts from 130 now down to 80.

Community groups opposed to the CPMC project as it now stands — including the Good Neighborhood Coalition, Jobs with Justice, and Coalition for Health Planning-San Francisco — commissioned the UC Hastings College of Law to study how CPMC’s charity care compares with other nonprofit hospitals in the city.

The result, “Profits & Patients: the Financial Strength and Charitable Contributions of San Francisco Hospitals,” was released Dec. 8 and was scheduled to be the subject of a public hearing at the Board of Supervisors on Dec. 13 after Guardian press time. Activists planned to use the hearing to highlight some of the report’s most damning conclusions about CPMC and its nonprofit parent company, Sacramento-based Sutter Health.

“Mainly due to Sutter Health’s plan to alter its current hospital structure within San Francisco, the provision of community health benefits by San Francisco hospitals is now a major issue before the Planning Commission and Board of Supervisors,” the report reads.

The report compares CPMC’s hospitals with St. Francis Memorial Hospital, St. Mary’s Medical Center (both are Catholic Healthcare West facilities), and Chinese Hospital, as well as noting how the city-run General Hospital provides by far the most charity care in town. The report finds CPMC is only spending about 1 percent of its revenues on charity care while the city sets a minimum standard of 3 percent.

Even before that project, CPMC/Sutter is the dominant health provider in town, and by far the most profitable. Between 2006-2010, the report says the company made $743.9 million in profits from its San Francisco operations, compared to St. Mary’s $22.6 million in profits and the $14.8 million loss by St. Francis.

“Our analysis shows that CPMC has the financial capacity to provide more of a share of services for uninsured and underinsured San Franciscans than it presently does, and that it is crucial for CPMC to do so in order to meet the city’s health care needs,” said Jeff Ugai, a Hastings student who worked on the study.

In 2010 CPMC’s three oldest campuses — Pacific, Davies, and California — provided charity care at a patients per bed rate less than half that of St. Francis, even though CPMC is triple St. Francis’s size and has much greater financial stability.

“St. Francis meets a huge amount of charity care patients. CPMC clearly can and should meet healthcare needs,” said Emily Lee, a member of the Chinese Progressive Association who spoke at a press conference announcing the report. “From the position of the coalitions, we want to see a project, and we want to see a good project.”

But CPMC, which has been resisting calls by Mayor Ed Lee and other city officials to commit to more charity care as a condition for its project, isn’t even accepting the report’s damning conclusions that it is extracting huge profits from San Francisco and giving little back.

“It depends on how you calculate it,” said CPMC spokesperson Kevin McCormack. “As a dollar amount, we give more in charity care than any other hospital except for General Hospital.”

That’s not surprising given that CPMC makes more money in San Francisco than any other hospital, enough that it has become a cash cow for the entire chain.

“CPMC-St. Luke’s is not only the most profitable hospital in San Francisco, but it is also the most profitable hospital in the Sutter Health statewide network. Out of twenty-one hospital groups within the Sutter Health network, CPMC/St.Luke’s brought in nearly one quarter of Sutter Health’s average net income over the last five years,” the report reads.

But McCormack says Sutter reinvests its profits back into the system.

“It goes back into the system itself,” he said. “It goes back into the hospital, into salaries, building new facilities, repairing old ones.” Yet the activists are unconvinced. Even before this report on charity care, they were critical of a CPMC project that includes housing on Van Ness with low rates of affordability, and which they say doesn’t rebuild St. Luke’s large enough to meet the community’s needs. It is also agreeing to operate St. Luke’s for only 20 years. “I like to call it a stay of execution,” said Jane Sandoval, who’s been a nurse at St. Luke’s for 26 years. “When CPMC took over with their master plan, it was an enigma to me how they concluded what the community needed. I know what the community needs, and I wonder who they asked.”

CPMC provides little charity care despite huge profits

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A new study has found that the California Pacific Medical Center (CPMC), an affiliate of nonprofit Sutter Health, provides far less charity care per paying patient than other hospitals in San Francisco even as it makes by far the most in profits, highlighting an issue that many city officials have raised as CPMC seeks permission to build a high-end new hospital on Cathedral Hill.

The study by UC Hastings College of Law is called “Profits & Patients: the Financial Strength and Charitable Contributions of San Francisco Hospitals,” and the Guardian reviewed an advance copy before its official release this Thursday. It compares CPMC’s hospitals with St. Francis Memorial Hospital, St. Mary’s Medical Center (both are Catholic Healthcare West facilities), and Chinese Hospital.

“Mainly due to Sutter Health’s plan to alter its current hospital structure within San Francisco, the provision of community health benefits by San Francisco hospitals is now a major issue before the Planning Commission and Board of Supervisors,” the report reads.

Even before that project, CPMC/Sutter is the dominant health provider in town, and by far the most profitable. Between 2006-2010, the report says the company made $743.9 million in profits from its San Francisco operations, compared to St. Mary’s $22.6 million in profits and the $14.8 million loss by St. Francis.

CPMC runs four of the largest hospitals in the city – St. Luke’s Hospital and CPMC’s Davies, California, and Pacific campuses – behind only San Francisco General Hospital, the city-run facility that does by far the most charity care. But while the other hospitals in the study are smaller, with much less staffed bed counts, they still manage to see the same or more charity care patients than CPMC.

For example, from the report, Saint Francis has 150 staffed beds and sees approximately 31 charity care patients per bed per year. CPMC has 514 staffed beds and sees only 14 patients per bed per year. “In 2010, CPMC’s three oldest campuses (Davies, California, and Pacific campuses) saw charity care patients at a patients per bed rate less than half that of Saint Francis, despite being more than 3 times the size of Saint Francis and having significantly greater financial stability,” read the report.

St. Mary’s and Chinese Hospital also see approximately 13 charity care patients per year per staffed bed, and their staffed beds are 160 for St. Mary’s and 31 for Chinese Hospital. If CPMC has so many more staffed beds, why aren’t their charity counts any higher than a hospital with only 31 beds to their 514 beds?

Hastings Professor Mark Aaronson, who put together the study, said that charity care is supposed to be at least 3 percent, the minimum expectation for the San Francisco Board of Supervisors. CPMC’s is closer to 1 percent.

Why is it so low? If you ask CPMC, it’s not. “It depends on how you calculate it,” said CPMC spokesperson Kevin McCormack. “As a dollar amount, we give more in charity care than any other hospital expect for General Hospital.”

Well, obviously. CPMC is a massive conglomerate that has four campuses to maintain and put money into to have the beds and staff available. Having so much more space than any other hospital, they would have to put in more as a dollar amount just to sustain those campuses.

Given that CPMC is a non-profit organization, where does that extra few tens of millions of dollars go? Well, some of it goes to hire the huge team of consultants and lobbyists who are now trying to win approval for the Cathedral Hill project. But McCormack said it also gets absorbed into CPMC operations.

“It goes back into the system itself,” said McCormack. “It goes back into the hospital, into salaries, building new facilities, repairing old ones.”

Even so, the report shows CPMC to be in a different category than other hospitals when it comes to supporting San Francisco’s full population. It also found that the profits extracted from San Francisco’s hospital subsidize the whole chain, a situation that will only become more pronounced as it builds a hospital at Cathedral Hill that seeks to draw patients from around the country.

“CPMC-St. Luke’s is not only the most profitable hospital in San Francisco, but it is also the most profitable hospital in the Sutter Health statewide network. Out of twenty-one hospital groups within the Sutter Health network, CPMC/St.Luke’s brought in nearly one quarter of Sutter Health’s average net income over the last five years,” the report reads.

The report was prepared for the Good Neighbor Coalition, Coalition for Health Planning — San Francisco, and Jobs with Justice. The official public release of “Profits & Patients” will be at 11 am on Thursday, Dec. 8, at the UC Hastings College of the Law, 100 McAllister St., Room 300, San Francisco.

Steven T. Jones contributed to this report.