President's Message: A New San Francisco General Hospital?

George P. Susens, MD

A committee has been formed to plan the new San Francisco General Hospital (SFGH), co-chaired by Mitchell Katz, MD, Director of Public Health, and Louise Renee, City Attorney. Representing the San Francisco Medical Society, I am one of approximately 25 individuals on the committee, which includes representatives from various city departments, from SFGH and from the University of California San Francisco Medical Center (UCSFMC), as well as several architects.

This committee was formed after the Public Health Commission decided to build a new 300-bed hospital. The Committee to Rebuild San Francisco General then proposed a site on 23rd Street-the current SFGH parking lot-at an estimated cost of $473 million. Some of the proposed improvements might be phased in over a period of several years, include $109.3 million to remodel and brace the existing building, $16.1 million to replace the service building electrical equipment (which, if done correctly, could pay for itself in 7-8 years) and $83.6 million for equipment.

Most of the costs for this mammoth project will probably be financed by general obligation bonds (GBO), which must be approved by a two-thirds margin of the voters. Some costs will be funded by other means (e.g., an estimated $11.5 million for the new parking garage may come out of money the city already has available).

Establishing the parameters, procedures and budgets for such an undertaking is a highly complicated process even when the ostensible process itself is firmly established. As it is, seven new bills have recently been introduced in the state legislature that would provide tax credits or bonds to help with financing of both public and/or private hospitals. And on February 23, 2001 Senator Jackie Speier introduced a bill (SB 842) that, if passed, adds further complexity to the debate by putting off the deadline for seismic upgrading until 2030, thereby eliminating the 2008 and 2013 deadlines. The senator argues that few hospitals have the capital to comply with current seismic law; that the practice of medicine is changing so quickly that no one knows what a hospital should look like in 30 years; that no patient in California has died in a hospital because of an earthquake since 1971; and that the public interest is best served by making incremental changes in existing structure [sic] and building on the normal capital cycle of hospital structures to attain compliance with the 2030 standard that hospitals remain operational during significant seismic activity.

The senator's bill and position on the provocative questions of this debate add a new dimension to the question of when a hospital should be rebuilt. It may be as long as two years before we know if SB 842 (or any of the other pertinent bills) will pass, how it might be amended if it does and, whether the governor would sign it if given the opportunity. Nonetheless, it is prudent to continue to plan for the new hospital if for no other reason than that waiting vastly increases the costs.

The team from UCSFMC is an essential component of the committee because of the close relationship between the two hospitals and because of UCSFMC's need to seismically upgrade its hospital as well. Coordination between the two projects is vital since the taxpayers will want to know that redundancies will not occur. The two institutions are now in nascent discussions regarding the possibility of combining some services.

The UCSFMC has five different plans to build a new 600-bed hospital. They will obtain environmental impact reports (EIRs) on each of the sites and then decide on the final location. The five prospects are:

1. Tear down the old (west) hospital building on Parnassus Avenue and build a large structure on that site.
2. Tear down Langley Porter and build half of a new hospital on that site. When it is completed, tear down Moffitt Hospital and build the second half of the new hospital.
3. Tear down the old Mt. Zion Hospital, acquire the block between Geary-Post and Divisadero-Scott and build there.
4. Build in Mission Bay north of 16th Street.
5. Build in Mission Bay south of 16th Street, where there is much more available space.

The pending EIRs will, of course, include neighborhood input, which may prove vital to the decision-making process.

I asked if the two hospitals should be combined. The experts argued, correctly, I believe, that a hospital larger than 600 beds is almost unworkable in size (matériel, parking, food, etc.) and that a single location would negatively alter the city's existing balance in hospital locations. In fact, I was told, the public's expressed concern of only two years ago that, "I don't want a new hospital built in my neighborhood," has changed to, "I don't want my hospital to move."

The seismic concerns require, in my opinion, that the medical community in San Francisco endorse both the SFGH and UCSFMC projects and, of course, the rebuilding of the city's private hospitals as well. Proposing the building of publicly funded hospitals takes diplomacy and salesmanship-especially in the case of SFGH because of voter objections to bond issues; but since current law requires seismic upgrading, there is no other choice, as I see it. The committee voted unanimously at its last session to recommend that the Health Commission take the bond issue to the public in 2002, and to proceed to plan for a complete rebuilding of SFGH as soon as possible, pending voter approval.

I am impressed by the competence and the efficiency of the Committee to Rebuild San Francisco General and by the quality of the people making the decisions. Former SFMS President Rolland Lowe is also on the committee and is asking penetrating questions. Is it possible to over-plan a project of such far-reaching implications for the citizens of this city? I doubt it.