Zenei Cortez Archives — San Francisco Bay Guardian Archive 1966

OPINION For 136 years St. Luke’s Hospital has been a San Francisco landmark, serving the underserved communities in the southern half of the city.

Now St. Luke’s needs San Francisco’s help.

The hospital’s owner, Sutter Health, has embarked on a stealth strategy to close St. Luke’s, shuttering units one by one and gradually shifting personnel to facilities in wealthier neighborhoods — and their more upscale pool of patients.

This process is called medical redlining, or institutional racism, and it’s not just morally wrong — it’s contrary to the values that unite San Francisco.

Latino and African American patients accounted for 54 percent of the 23,000 emergency visits to St. Luke’s in 2005. This compares with only 8 percent at Sutter’s favored California Pacific Medical Center facilities across town. Similarly, 40 percent of hospital patients at St. Luke’s are Latino, versus only 1 percent at the CPMC site. There are 1,300 children born each year at St. Luke’s, most of them to families from the Mission, Bayview–Hunters Point, the Excelsior, and surrounding communities.

If St. Luke’s closes, where will these patients go? What will they do?

Some of them will head to San Francisco General Hospital, which is already struggling with too many patients and uncertain funding.

Sutter says it will treat the rest of these patients at its other facilities — all at least a 30-minute drive or a much longer bus ride away.

In reality, many patients will simply forego medical treatment. A recent study in the Journal of the American Medical Association found that for lower-income patients, "traveling across town to access better resources or health care facilities is often beyond their means."

In this context, Sutter’s latest cuts to the neonatal intensive care and pediatrics units are especially cruel. Since the only private hospital serving the southern half of the city is in danger of closing, many of these families with sick babies and children will not seek or receive the medical attention they need until a crisis arrives.

All this, to improve on Sutter’s 2006 profits of $587 million.

The good news is that it’s not too late to save St. Luke’s.

Sutter’s actions have sparked a community outcry. Registered nurses from the facility went on strike in October and continue to insist that Sutter stop bleeding the hospital dry. Doctors, patients, and public health groups have actively protested and organized against the chain, and the city’s Health Commission is considering its options.

Sup. Sophie Maxwell recently introduced groundbreaking legislation to require a health impact review of all new permits granted to medical facilities. This would force Sutter to present an institutional master plan before moving forward with its proposed facility on Cathedral Hill and to justify this expensive new project in terms of what is best for the citywide public health infrastructure.

On a parallel track, Sup. Ross Mirkarimi is proposing a resolution to give the Board of Supervisors more influence over Sutter’s plans and to direct the city attorney to explore legal options to counter Sutter’s medical redlining.

As the cuts at St. Luke’s continue, patients suffer — and so does the city’s health care safety net. It is time for San Franciscans to join together and save this city icon. *

Zenei Cortez, RN, is a member of the Council of Presidents of the California Nurses Association.

OPINION If you’re one of the 6.5 million Californians without health coverage, get ready to find a lot of hands in your pocket.

Gov. Arnold Schwarzenegger’s much-trumpeted health plan is the most ambitious overhaul of the state’s health care system since … well, since SB 840, the far simpler, more universal, more comprehensive, single-payer health plan sponsored by Sen. Sheila Kuehl, which the governor vetoed last September.

Unlike a single-payer system, with one entity that pays for everything using existing private hospitals and doctors and offers one standard of quality care for all, the Schwarzenegger plan is a mishmash likely to saddle more Californians with unaffordable, inferior coverage while opening a new gilded age for insurers and banks.

Once the legislature prunes away the proposed new tax on employers, hospitals, and doctors (which is likely) and eliminates the laudable pledge to assure coverage for the undocumented, the governor’s plan is apt to end up stripped down to its worst elements — a mandate that all individuals have to buy health insurance and the dubious promotion of a Bush administration scheme, health savings accounts.

Individual mandates turn the whole purpose of health care on its head — they criminalize people, rather than helping them. If you don’t sign up for a plan, you could become ineligible to get a job and enroll your child in school or face tax penalties.

With no controls on skyrocketing premiums, comprehensive plans will be out of reach for millions of Californians. Most could end up with junk insurance, with up to $10,000 in out-of-pocket payments for any medical care, meaning the average person will likely pay for all his or her medical expenses on top of the premiums. And many may forgo any medical care, risking worse health problems and greater health costs down the road.

Even lower-income people who qualify for the state subsidy could end up paying out 6 percent of their income. Presumably, they’ll just cut back on food or rent — at the same time that the governor has announced plans for welfare cuts.

Then there’s the $2 billion now used for indigent care at mostly public hospitals that will be siphoned off into the pool for buying insurance, ravaging our public health social safety net.

But the insurance companies will suddenly get millions of new customers, who will be buying insurance at gunpoint. No wonder Blue Shield CEO Bruce Bodaken says of the plan, "There’s a lot to like."

If nothing else, the Schwarzenegger plan — and the lite versions proposed by the Democratic leaders of the Senate and Assembly — should be a call to action for the rest of us to press harder than ever for the enactment of the soon-to-be-reintroduced single-payer Kuehl bill. *

Zenei Cortez

Zenei Cortez, RN, is the vice president of the California Nurses Association.

Zenei Cortez

Save St. Lukes!

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