Staff recommends CPMC compliant for 2021; commissioners press Sutter on labor-and-delivery, subacute beds and Tenderloin services

San Francisco planning and health staff told a joint hearing on May 11, 2023, that California Pacific Medical Center (CPMC), part of Sutter Health, met most obligations in the Van Ness/Gary development agreement for calendar year 2021, but flagged several ongoing community concerns.

Elizabeth Pearl of the Planning Department and Max Grama of the Department of Public Health summarized the annual review process and recommended that the directors of planning and public health find CPMC in compliance for 2021. Staff said Deloitte verified CPMC's charity-care and community-benefit reporting: CPMC reported caring for 30,779 unduplicated charity/medical patients in 2021 (the DA baseline was 30,345) and reported roughly $16.5 million in community benefits against an $8 million requirement. An innovation fund referenced in the DA totaled $8.6 million across four years and was completed in 2020.

Despite those findings, commissioners pressed staff and CPMC representatives about several unresolved service issues. DPH and planning staff said labor-and-delivery inpatient services at the Mission Bernal campus were temporarily relocated during the COVID surge and that CPMC did not provide the six-month prior notice required by the development agreement; DPH found that earlier action noncompliant in the prior review but did not re-find noncompliance for 2021 because the action occurred outside the reporting year. DPH said it continues to monitor the closure and that CPMC has indicated plans to restore labor-and-delivery services but has not provided a timeline. Pamela Kaunakki, interim CEO of CPMC, said the hospital will set up a meeting with DPH after the hearing to discuss a safe return and is not waiting for the agency to initiate that discussion.

Commissioners also pressed CPMC and staff on the shortage of subacute and skilled-nursing (SNF) beds in the city. Planning and DPH staff described ongoing, citywide efforts to expand subacute capacity and said CPMC has shared discharge data and is open to partnering. Commissioners urged the hospital to take a more active role in finding near-term solutions to keep San Franciscans in the city rather than sending them out of county.

Several commissioners raised concerns about whether DA provisions intended to increase Medi-Cal enrollment in the Tenderloin have been met. Staff and CPMC representatives said the DA envisioned the creation of a new Managed Services Organization (MSO) in the Tenderloin; because no new MSO was created before a 2015 cutoff, the requirement to enroll 1,500 new Medi-Cal beneficiaries tied to a new MSO did not apply. CPMC reported that NEMS MSO opened a clinic at 650 Polk in 2020 and that roughly 8% of its 4,500 Tenderloin patients were new enrollees in 2020 (about 300), but staff said CPMC could not provide a definitive unduplicated new-enrollee count for Tenderloin in time for the hearing and that they will continue to follow up.

Planning staff also reminded the commissions that the development agreement contains a transportation demand management (TDM) obligation to reduce single-occupancy vehicle trips by 15% from a 2013 baseline; the obligation is enforceable by 2024. Staff and Sutter representatives said pandemic-era commute changes have hindered progress, but SFMTA will continue monitoring and CPMC retains several measures it can deploy to meet the goal.

Public commenters described harms from service reductions. A caller, Dr. Teresa Palmer, alleged that CPMC prioritized profitable, short-stay acute care while cutting services for underserved patients and accused the health system of failing to notify the city about labor-and-delivery changes. Other callers and an in-person commenter, Billie Jean Wall, urged restoration of the Community Aquatics Exercise Program and therapy-pool access used by medically referred patients. CPMC's Melissa White said Davies pool closed during the pandemic, reopened, and was later closed for repairs to a pump and lift; she estimated reopening by August or early September and said the pool operates for 1:1 therapy with a physician's order.

Staff will finalize their written findings and the directors of planning and public health will determine compliance. A third-party monitor will review the directors' determinations and advise the Board of Supervisors. Commissioners asked staff to follow up with CPMC on timelines for restoring labor-and-delivery services, additional details on Tenderloin enrollment, subacute bed partnerships, and TDM progress. The development agreement expires in August 2023, though several DA obligations continue after that date and at least one additional public hearing was expected.