Other options for St. Luke's

The hospital means too much to the city to lose it

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EDITORIAL California Pacific Medical Center wants to build a fancy new hospital in San Francisco without meeting the city's demands for housing, transportation, and health-care mitigations. And the arrogant leadership at the private nonprofit thinks it can hold the city hostage: If the mayor and the supervisors don't approve the new medical complex on Van Ness Avenue, CPMC has threatened to close St. Luke's — threatening a critical part of the local health infrastructure.

It's a dangerous game: CPMC must rebuild its aging California Street facility to meet state seismic safety codes, and, given the importance of the San Francisco market, clearly isn't going to do a Twitter and threaten to move out of town. The city can't afford to lose St. Luke's — other than the overburdened SF General, it's the only hospital on the south side of town and a critical, life-saving facility for residents of the low-income southeast neighborhoods.

But CPMC keeps leaving itself ways to abandon the Mission District facility. And even the offer to save the hospital is weak: The facility would be cut almost in half, to only 80 beds.

So it's time to come up with other options, ways to take that CPMC gun away from San Francisco's head and ensure the future of health care in the southeast. And city officials ought to be willing to try unusual ideas. Here's one:

Why not seize St. Luke's under eminent domain and ask the University of California, San Francisco to help run it?

It's not as crazy as it sounds. CPMC insists the facility is old, needs its own seismic rebuild and loses money. So it's not as if the health-care giant could demand some huge compensation. The city could probably get it for next to nothing.

St. Luke's isn't profitable — but that's in part because CPMC has shifted some of the more lucrative services to its other campuses.

UCSF already provides the medical residents for SF General, which operates in part as the medical school's teaching hospital. UCSF is also expanding rapidly, investing huge amounts of money into its new Mission Bay campus. The idea of integrating St. Luke's into the school's training and research programs makes a certain amount of sense.

The city — and perhaps UCSF — would need to pay for the seismic upgrade, no small deal, and in the short term, cover operating losses. But the city's going to have to pay those costs one way or another: The way CPMC is talking, most of the costs of rebuilding St. Luke's will be passed on to the taxpayers and to local health plans (including the taxpayer-funded city health plan) anyway. If nothing else, CPMC wants the city to absorb the massive costs of mitigating the housing and transit impacts of the Van Ness hospital in exchange for keeping a (diminished and inadequate) St. Luke's alive. The closure of St. Luke's would put fiscally unbearable demands on SF General.

And guess what? The minute city and state officials start talking about an alternative future for St. Luke's, CPMC and its parent, Sutter Health, lose the only real leverage they have to demand a bad deal for the Van Ness project.

It's at least worth talking about.