No room at San Francisco hospitals

When it comes to the capacity of San Francisco hospitals to treat an onslaught of patients in any sort of local disaster, the diagnosis is bleak. Half of The City’s hospitals are rated as overcrowded, exceeding the ideal occupancy level of 80 percent to 85 percent. And in less than 25 years, there will be a significant shortage of acute-care beds. Unless new capacity is added, San Francisco will be short 533 acute-care beds by 2030 — 24 percent less than needed.

Thisgrim prognosis comes from national hospital-consulting firm Lewin Group’s just-completed report for the Controller’s Office. The report’s timing is presumably related to the $800 million bond measure for rebuilding San Francisco General Hospital that city voters can expect on the November ballot. This will be the largest municipal bond measure in San Francisco history, but it is directed at meeting the statewide hospital earthquake-proofing deadline, not enlarging the aged facility that operates at 97 percent occupancy.

San Francisco General Hospital is vital to The City’s well-being. It contains the Bay Area’s only trauma center north of Stanford and accounts for 15 percent of The City’s acute beds. The hospital also provides more than half of the psychiatric, HIV and substance-abuse care in San Francisco.

City Controller Ed Harrington said the report “highlights key challenges” for medical care in San Francisco during the next decades, particularly a need to increase the number of outpatient clinics handling more routine health services. Harrington is correct to state that more community clinics are needed for lessening the unnecessary burden on city emergency rooms. But that only addresses part of a stubborn, multifaceted problem that will require considerable creativity in order to make improvements.

Since money and land available to enlarge public or not-for-profit hospitals will be hard to come by in the foreseeable future, the first line of attack must be to revamp wasteful practices. For example, every time a 911 call reports somebody passed out in the street, it costs approximately $3,000 to dispatch an ambulance and transport the victim for emergency room treatment. However, thousands of such calls each year involve a few hundred chronic alcoholics who are well-known to authorities and could just as appropriately be taken in a van to the Public Health Department’s sobering-up center on Fell Street — at a potential annual savings of some $11 million.

There is also an emerging trend of not-for-profit hospital chains consolidating their more expensive services at just one facility in The City. Perhaps Public Health officials need to analyze the results of this movement and take steps to prevent the loss of existing acute-care capacity. And as a short-term crisis backup, an agreement should be made for transferring less critical patients to adjacent San Mateo County, which at least temporarily has some available hospital capacity.

But even if ways are found to bring more disaster-overflow beds into service, thought must also be given to quickly obtaining sufficient doctors and nurses to cope with the first surge of injured.

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