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West of Twin Peaks Observer
March 2008

SF General Hospital:  Rebuild vs. Retrofit
by Ahimsa Porter Sumchai, MD

The Environmental Review for SF General Hospital Seismic Compliance Hospital Replacement is slated for release to the public in March of 2008.

San Francisco General Hospital is a 130 year old institution.  It is the only Level 1 Trauma center serving San Francisco and Northern San Mateo county.  The hospital operates 282 acute medical and surgical beds that are filled to capacity 97% of the time.

Ambulances are forced to divert to other hospitals in San Francisco over 20% of the time because of this critical shortage in bed capacity.  The hospital is one of two located within the cities southeast sector, providing primary and emergency services to predominantly low income communities of color.  St. Lukes Hospital is currently threatened with closure including its emergency services.

In 2004 a Blue Ribbon Committee recommended that a new acute care hospital be constructed on the West Lawn of the SFGH Medical Center campus facing Potrero Avenue.  Other options were explored including the co-location of a new acute care hospital to the Mission Bay campus where UCSF is also planning to construct a new hospital that will be operational by 2014.

The proposed new General Hospital will increase its acute care bed capacity by one bed!  The hospital will increase four times in area.

The existing main hospital, like over 500 hospitals in the state of California, does not meet the seismic safety standards mandated by Senate Bill 1953.  This legislation followed the collapse of a hospital in the aftermath of the 1994 Northridge earthquake.  It requires all California acute care hospitals to remain intact and fully operational in the aftermath of a major earthquake.

SB 1953 does not require that SF General Hospital be rebuilt. It mandates that any hospital not retrofitted by this year that poses a risk of collapse or loss of life cannot be used for acute care until it has been stabilized.  Because public funding does not exist to upgrade the state's hospitals, many facilities have applied for a five year extension.

On November 4, 2008 SF voters will be asked to pass an $800 million dollar bond measure to fund the SFGH rebuild.  Consider the following facts:

1. The expansion of bed capacity by one bed represents a serious overall reduction in services.  The May 2006 report of the Civil Grand Jury on Disaster Medical Preparedness identified the need for up to 600 surge capacity beds in the setting of a major disaster or public health emergency.  Additionally, an independent consultant retained by the Controllers Office, reported that half of SF's hospitals are operating at an 85% occupancy level and the city faces a 533 acute care bed shortage over the coming years.
   
2. The EIR for the SFGH rebuild may not adequately analyze the significant noise and safety impacts of the simultaneous construction of the new hospital on the West Lawn, while the existing hospital in Building 5 remains fully operational.  The EIR proposes the relocation of a rooftop helipad from Building 5 to the new main hospital without an adequate analysis of noise, safety and flight arrival and departure routes.  The EIR for the proposed rooftop helipad on Building 5 has yet to be released to the public.  There is concern that the delay in release of the SFGH Helipad EIR is deliberate and intentional given the organized opposition to the siting of helipad at the hospital that has existed for over 20 years.  Aeromedical helicopter crash rates have increased according to a USA Today database.  The noise, rotor wash and potential aviation disaster posed by a helipad cited in a dense, unaccepting urban neighborhood adjacent to freeways and within one mile of downtown San Francisco cannot be ignored.
   
3. The EIR for the SFGH rebuild may not adequately analyze the seismic retrofit alternative for the existing hospital given evidence that it may be more cost effective and less time intensive.  Given the $227 million dollar budget shortfall and the $25 million dollars from the General Fund that will be encumbered by the Rebuild project in FY 2007–2008, alternatives should be considered.

These alternatives must also include a co-location of the planned UCSF acute care hospital and the SFGH acute care hospitals to the Mission Bay Campus.

Ahimsa Porter Sumchai, MD

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