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Dumping mom and dad out of county

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St. Luke’s is operated by California Pacific Medical Center. (Mike Koozmin/2013 S.F. Examiner)

Out-of-county patient dumping of San Franciscans following hospitalization is certain to increase.

San Francisco is poised to lose its only skilled nursing facility (SNF) providing sub-acute care for patients who need ventilator care or who need routine post-acute hospitalization rehabilitation.

St. Luke’s, operated by California Pacific Medical Center, announced June 6 it’s closing its SNF unit Oct. 31, without explaining why it’s closing it two years earlier than planned in 2019.

Licensed for 79 SNF beds, it currently has 44 patients who face out-of-county placement as far away as Sacramento.

The Department of Public Health confirmed that during the five-year period between July 1, 2012, and June 30, 2017, The City’s two public hospitals — Zuckerberg San Francisco General Hospital and Laguna Honda Hospital — have discharged 291 San Franciscans out of county. DPH has refused to provide out-of-county discharge data for the six-year period between July 1, 2006, and June 31, 2012, although it most likely has that data. That’s the period when LHH was downsized by 420 SNF beds due to the $71.6 million in change orders involving the rebuild project’s massive cost over-runs, and when there were likely substantially more out-of-county discharges.

Unfortunately, private-sector hospitals haven’t reported how many out-of-county discharges they’ve made across the corresponding periods. A report from DPH in February 2016 — “Framing San Francisco’s Post-Acute Care Challenge” — documented private-sector hospitals cited out-of-county placement as necessary to transfer patients from acute care to lower levels of care. All acute care hospitals other than CPMC transfer sub-acute patients out of county. The number of private-sector out-of-county discharges weren’t reported.

St. Luke’s hasn’t reported ethnicities of patients impacted. It’s unknown how many Latinos in the Mission and in San Francisco will be affected.

The report noted that between 2001 and 2015, there has been a 43.4 percent decline in San Francisco’s SNF beds — from 2,331 to 1,319 — primarily driven by SNF closures within acute-care hospitals.

Based on current utilization rates, by 2030, San Francisco faces a 68.6 percent deficit — a 1,745 shortage — in SNF beds needed, driven by projections San Francisco’s current 113,000 people age 65 and older is expected to grow to 192,000 (20 percent of our total population) by 2030, a 69.9 percent increase.

Among other recommendations the report noted because San Francisco is at risk of an inadequate number of SNF beds, that the Post-Acute Care Collaborative explore options to bring new SNF capacity to market. No follow-up recommendations have been presented to the Health Commission, which hasn’t discussed post-acute care issues since 2016. Our new Dignity Fund, which will be awarded $575 million by July 2026, prohibits spending for hospital, or SNF, services.

In 1977, California passed the “Beilenson Act,” authored by former state Sen. Anthony Beilenson, requiring county Board of Supervisors hold public hearings whenever county-operated health care facilities propose closing or reducing services.

In 1988, San Francisco voters placed Proposition Q on the ballot requiring our Health Commission hold public hearings on private hospital closures. Prop. Q explicitly required that the Health Commission determine whether private hospital reductions would have a detrimental effect on the health care of San Franciscans.

Creatively, in 2015, Health Commission President Dr. Edward Chow claimed a new City Attorney opinion allows the commission to avoid ruling whether there would be detrimental effects from private-sector closures. The City Attorney’s Office claimed a secret attorney-client privilege and refused to disclose the advice provided to the commission, which resulted in overturning the will of the voters during Prop. Q hearings.

The Board of Supervisors Public Safety and Neighborhood Services Committee is holding a hearing on closure of St. Luke’s SNF unit today at 10 a.m. in Room 263 at City Hall. That will be followed by two Prop. Q hearings before the Health Commission at 101 Grove St., Room 300 on Aug. 15 and again on Sept. 5, at 4 p.m. on both dates.

It’s time to attend these meetings and submit written and oral testimony opposing out-of-county patient dumping of San Franciscans.

Patrick Monette-Shaw has been a columnist for the Westside Observer for more than 15 years; he operates www.stopLHHdownsize.com. Dr. Teresa Palmer worked as a Senior Physician Specialist at LHH for 15 years and has practiced medicine in San Francisco for 30 years.

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