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As SF hospital preps to close unit, remaining patients complain of neglect

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Supervisor Ahsha Safai called a committee hearing Wednesday to address the closure of St. Luke’s subacute care unit and The City’s shortage of subacute beds. (Mira Laing/Special to S.F. Examiner)
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Hospital officials denied allegations Wednesday that fragile patients at the last subacute unit at a hospital in San Francisco are falling from beds, contracting infections and suffering from bedsores more often than before the hospital cut staffing.

About half of the nurses who cared for patients in the subacute unit at St. Luke’s Hospital have relocated or left since Sutter Health’s California Pacific Medical Center announced in June that it would close the unit.

Family members like Gloria Simpson, whose sister is a patient in the subacute unit, claim the staffing reductions mean patients and equipment are being cleaned less frequently, leading to increased health concerns.

“It was back-to-back, like within three months she had two infections,” Simpson told the San Francisco Examiner. “You know what it is to take antibiotics for so long, it’s not even healthy.”

The allegations come as San Francisco grapples with a shortage of subacute beds for patients on ventilators and feeding tubes. Supervisor Ahsha Safai called a committee hearing Wednesday to address the crisis and closure of the St. Luke’s subacute unit.

Political pressure pushed CPMC to agree in September to delay the closure of the subacute unit at St. Luke’s Hospital from October until June 2018. CPMC also agreed to transfer the patients to another hospital in San Francisco and continue caring for them until their deaths.

But the agreement came after 31 of the 61 staff members working in the subacute unit had already relocated to other positions or accepted severance packages, according to a letter CPMC sent families Monday.

CPMC CEO Dr. Warren Browner denied the allegations at Wednesday’s hearing. Browner said an internal investigation found “no changes to the quality of care” the unit provided since the closure announcement.

Browner also said staffing levels “haven’t changed.”

“It may seem like there are fewer staff members, but that’s because there are fewer patients,” Browner said. “The ratio of staff to patients remains above required levels.”

CPMC plans to relocate the patients to the CPMC Davies Campus in June 2018 at the earliest, Browner said.

But their relocation does not solve the subacute care problem for the rest of San Francisco.

“It’s one thing to say that we are going to provide the care for existing patients,” Safai said. “We definitely need to have a long-term conversation on subacute care in San Francisco.”

Subacute care is a type of care offered at skilled-nursing facilities in hospitals or community centers.

The shortage of subacute care beds stems from hospitals in San Francisco reducing their number of skilled-nursing beds by 43 percent, according to Sneha Patil, a senior health program planner with the Department of Public Health.

San Francisco has also experienced an overall decline in skilled-nursing beds from 3,500 to 2,439 since 2003.

Browner said hospital systems are no longer building skilled nursing facilities or subacute beds because the costs are too high. CPMC and other systems build hospitals to expensive seismic standards for patients in acute care.

“It’s prohibitive to also include subacute beds in that same structure,” Browner said. “They should be built in either distinct facilities that are just for SNFs that don’t need to meet the state’s new requirements.”

Browner said skilled-nursing or subacute beds could also be built in old facilities without cost impacts.

DPH Director Barbara Garcia said the department is in talks with Dignity Health’s St. Mary’s Medical Center to purchase and open subacute beds at the hospital.

“They have had empty space in their hospital now for several years,” Garcia said at the hearing.

Garcia said San Francisco should have about 70 subacute beds. The St. Luke’s subacute unit had 40 before CPMC planned to close it.

“We have to put this in the front and center in our needs,” Garcia said. “The data shows we’re going to need more.”

DPH is expected to release a short-term and long-term plan next spring to address the crisis.

Safai called for another hearing on the St. Luke’s Hospital closure and subacute issue on March 28.

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