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A community and labor coalition has just won a years-long battle against the largest private healthcare provider in San Francisco

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DYAN RUIZ, TRNN PRODUCER: Community organizations and labor in San Francisco have just won a years-long battle against the largest private health-care provider in the city. Their victory against the odds could serve as a model for other communities battling huge corporations. One the one side, there’s California Pacific Medical Centre, the most profitable health-care corporation in San Francisco. They wanted to build a new, centrally located mega-hospital that would meet new earthquake requirements. On the other side, a labor-community coalition fighting to ensure quality health services in and for marginalized communities.

GORDON MAR, EXECUTIVE DIRECTOR, JOBS WITH JUSTICE: I think the coalition really saw that CPMC was really no different than other big powerful corporations, self-serving corporations, from WalMart to the big banks.

PAUL KUMAR, CONSULTANT, NATIONAL UNION OF HEALTH CARE WORKERS: And it would take a monumental effort to get them to approach the San Francisco health-care market in a different way.

BOB PRENTICE, FORMER DIRECTOR, BAY AREA REGIONAL HEALTH INEQUITIES INITIATIVE AND REPRESENTATIVE ON CITYWIDE PANEL ON ST. LUKE’S, BERNAL HEIGHTS NEIGHBORHOOD CENTER: It was a matter of insisting that if CPMC wanted to carry out their business plan, they had to do it in a way that would serve all of San Francisco. So it became a big fight for social justice.

RUIZ: Many have criticized California Pacific Medical Center for prioritizing profits over the health-care needs of San Francisco’s marginalized communities.

PRENTICE: There was a time when a health-care system in a city like San Francisco would be subject to some kind of a planning oversight. But that period disappeared in the Reagan era, and decisions started to be left up to the market.

DAVID CAMPOS, SAN FRANCISCO BOARD OF SUPERVISORS, DISTRICT 9: The big difference in Northern California is that you have a larger number of beds that are controlled by one entity, and that is Sutter. And that, because of that, that has led to health-care costs being higher in Northern California, significantly higher, than they are in Southern California.

NATO GREEN, FORMER UNION REP, CALIFORNIA NURSES ASSOCIATION: Sutter, CPMC’s parent corporation, would report, year after year, five hundred, six hundred million dollars in profit.

RUIZ: Ironically, it was CPMC’s anti-competitive practices that put them in control of an important charity care hospital, St. Luke’s. St. Luke’s accused CPMC of skimming insured patients and filed an anti-trust lawsuit. The settlement resulted in an unexpected twist: CPMC agreed to support St. Luke’s core services, including inpatient care. St. Luke’s later became part of CPMC. Since taking over the hospital, CPMC had constant battles with the California Nurses Association, including fighting over who pays for health-care benefits.

GREEN: The way that they cut health benefits to nurses was particularly incredible because they were a health-care company employing nurses, and they wanted to make nurses pay more to get health care from them.

RUIZ: Community groups and labor organized in coalition against CPMC when they came out with their Institutional Master Plan in 2008. It included building a 555-bed hospital with specialized services and a medical office building at Van Ness and Geary on Cathedral Hill. Hospitals had to meet new earthquake safety requirements. CPMC wanted to build new facilities instead of retrofitting their existing hospitals.

PRENTICE: They were going to close inpatient care at the Pacific campus. They were going to close the California campus altogether. And consistent with that, they were going to close inpatient care at St. Luke’s and argue that all inpatient care will now occur at this highly specialized hospital at Van Ness and Geary.

RUIZ: One of the major issues that community and labor groups were concerned about was the closure of St. Luke’s.

PRENTICE: St Luke’s is the only private nonprofit hospital in the southeastern half of the city. If you think about some of the neighborhoods that that means, it’s like Bayview Hunters Point, it’s Bernal, it’s Mission, it’s Excelsior, it’s Ingleside. You know. Apnd who lives in those neighborhoods?

DEANNE LIU, CORE LEADER, CHINESE PROGRESSIVE ASSOCIATION, YOUTH MOJO: I have been outreaching in the Excelsior neighborhood for about three years now, and I do spend a lot of time there, so what I see is that I do notice a lot of people of color. There’s been a lot of people who are not insured or they have inadequate health care.

TELESFORE UNITE, BAYVIEW RESIDENT AND LEADER, BERNAL HEIGHTS NEIGHBORHOOD CENTER: Most people really go to St. Luke’s in this area. They don’t ask so much as long as you have your Medicare, Medi-Cal and it’s okay.

PRENTICE: People who live in Bayview Hunters Point can expect to live on average fourteen years less than people who live on Russian Hill. You’re talking about two neighborhoods in the same city. And how do you explain that difference? And it is so tied to people’s day-to-day living conditions, everything from the physical environment of their neighborhood to the history of racism and how decisions got made about who lives where and what else is part of that way of life, from ports and railroads and freeways and power plants and sewage treatment plants. So that’s the large sense of what health equity is. Within that there is also the question about who has access to health care.

RUIZ: If services at St. Luke’s charity care hospital were to close, then poor and uninsured patients would have little choice but to access San Francisco’s public health facility, SF General. But with no citywide health planning, some services at SF General, like inpatient psychiatric units that were being shut down at St. Luke’s, might not have the capacity to absorb additional patients. Those patients would likely end up in the public health system’s emergency care, or the public health system would have to increase services at a cost to taxpayers.

GREEN: What we discovered was that on the way to CPMC trying to close St. Luke’s outright that it really felt like death by a thousand cuts, that they were continually undermining the hospital and making it less of a viable hospital, so that when they hit the five-year mark and completed their commitment, they can say, see, this isn’t a functional hospital; we need to abandon it.”

RUIZ: When the development plan to build a new facility on Cathedral Hill became public, groups throughout the city started mobilizing against the plan. Two coalitions consisting of community groups and labor joined forces to stand up for the needs of workers and marginalized communities.

GREEN: There was a labor issue; there was a health-care issue in terms of access to services. It was a business plan that affected five different neighborhoods. It affected housing, it affected transit, it affected city services, it affected taxpayers, it affected other hospitals. And so there was something for everyone to hate.

JAMES TRACY, GOOD NEIGHBOR COALITION: When we talk about the ideal of community and labor working together for progressive social change, that’s a wonderful goal. But we all know that it’s really hard to maintain.

RUIZ: Most of the members of the coalition were nonprofit community-based organizations, and they were going against the huge resources of CPMC Sutter. The groups also had to learn how hospitals do business to understand what CPMC was telling the public.

GREEN: They spent years hiring one consulting group after another and marketing firm and pouring enormous sums of money into advertising and publicity stunts and bringing men in suits to hearings who would throw down reams of paper on tables and say, this proves that we’re right and you should give us whatever we want.

PRENTICE: This was going to be a huge development–a big hospital on one of the busiest intersections in the city, a medical office building across Van Ness Avenue with a tunnel underneath, a parking garage. They were going to also become the largest private employer in San Francisco. So these were, like, huge stakes, and the leverage we had was the development proposal, was the city’s authority to approve or amend a plan for development.

RUIZ: The land use approval process became the public’s forum for speaking out on issues such as health care, employment, housing, and transit. In San Francisco, development proposals of this scale ultimately end up at the Board of Supervisors for a final decision.

LEE: So one of the demands that the coalition was pushing for was that any agreement between St. Luke’s has to have a plan for the viability and sustainability of St. Luke’s for the long term.

GREEN: The way private non-profit hospitals work when they are going to be a safety net hospital is that they tend to have a variety of services that lose money, like an emergency room, that meet the health-care needs of a community, and that is offset by having some profit center. Usually it’s some type of surgery that they do that is for insured patients. And we said we want St. Luke’s to have an anchor. We don’t want it to just be the least amount of hospital that you need to support an emergency room. We want it to have something like neurosciences that will make it a viable hospital.

RUIZ: Despite the coalition pushing back, CPMC kept pushing their development plan forward. A critical moment came in spring 2012 when the Board of Supervisors did not approve the plan.

MAR: Because of the successful work of our coalition in presenting a broad unified platform and a broad coalition, we were able to win over the support of a majority on the Board of Supervisors to say that that deal was not good enough. And that really forced CPMC to come back to the table to renegotiate a new deal. Bt this time it wasn’t just with the mayor’s office at the table, which it had been up till that point, but now, beginning in the fall of 2012, the new round of negotiations included three representatives–three members of the Board of Supervisors.

RUIZ: Early this year, Supervisors Chiu, Farrell, and Campos worked with Mayor Lee and brought in a mediator, Lou Giraudo. Out of those sessions, a final development deal significantly different from the original was struck. Despite repeated attempts, CPMC Sutter Health declined an interview for this story with The Real News Network. Here’s CPMC’s CEO presenting the latest proposal.

WARREN S. BROWNER, CPMC CEO: Our proposed new health-care facilities are different from one we presented to the Planning Commission last year. They fit well with the future of health-care and future population growth in San Francisco. The Cathedral Hill campus, while smaller than our proposal last year, will still be our largest campus. We look forward to serving patients from throughout San Francisco at this new, centrally located facility. In addition, we recognize that the demographics of San Francisco are changing and that more families are living and working south of Market. Our revised plan with a larger hospital at St. Luke’s campus reflects the changing demographics of the city.

RUIZ: The new development proposal was unanimously approved on June 25 by the Board of Supervisors. This version includes many of the coalition’s demands. Most significantly, the new Cathedral Hill hospital will be close to 50 percent smaller and St. Luke’s hospital will be 50 percent larger than originally proposed.

GREEN: It was supposed to be closed by 2009, and it’s 2013, and not only is it still open, but CPMC is going to be investing $300 million in rebuilding it.

RUIZ: Shortly after the new development agreement was announced this spring, CPMC agreed to fair contracts with the California Nurses Association and the National Union of Healthcare Workers.

CAMPOS: This outcome and this project is an example of how coalitions, in this case of community and labor, can truly make a difference, can truly lead to an outcome that no one thought was possible.

RUIZ: People are now saying that if CPMC actually built the development they initially wanted, they would have sunk massive amounts of money into a project that was financially unsustainable, especially given the implementation of the Affordable Care Act. The Act changes the way people are insured and the amount paid for services. So the amount of revenue CPMC could expect from the proposed huge, highly specialized facility is far less than before.

PRENTICE: In fact, the mediator even said to the folks in the coalition at one point, you know, I think you guys might have done them a favor.

KUMAR: The community coalition, however badly despised we might have been by various elements in CPMC and Sutter Health, had actually saved Sutter Health from itself.

LEE: I think now we’re trying to figure out, well, what does accountability look like, what do we need to do to make sure that it just doesn’t look good on paper but it actually happens in the right way and it happens with the community input and process. So I think that’s kind of getting figured out right now is what does accountability and monitoring look like and enforcement of the terms of the development agreement. But I think overall we feel really excited about that we can say that, yeah, St. Luke’s is going to be around for the long term.

RUIZ: The victory for the labor community coalition not only saved a critical hospital serving marginalized communities in San Francisco; the new plan will also ensure employment opportunities, new affordable housing, and was a huge step forward for CPMC’s relationship with its unions. In the end, the years-long struggle will benefit not only the communities represented in the coalition, but all San Franciscans for decades to come.

This is Dyan Ruiz for The Real News Network.

Joseph Smooke, a producer on this story, was housing director, then executive director of Bernal Heights Neighborhood Center, a lead organization in the Save St. Luke’s coalition and the Coalition for Health Planning San Francisco.


DISCLAIMER: Please note that transcripts for The Real News Network are typed from a recording of the program. TRNN cannot guarantee their complete accuracy.

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Joseph Smooke, a Producer on this story was Housing Director then Executive Director of Bernal Heights Neighborhood Center, a lead organization in the Save St. Luke's coalition and the Coalition for Health Planning San Francisco