SFGH Seeks Voter Support to Rebuild Hospital

Voters will decide on Nov. 4 whether to support Proposition A, an $887.4 million general obligation bond measure that would pay for construction of a new San Francisco General Hospital (SFGH) and trauma center to meet state-required standards for seismic safety. If approved, construction could begin in 2009 on the 284-bed, 440,000-square-foot acute care hospital and trauma center, related site and campus improvements, new central utilities, and additional emergency generators. Completion of the project is scheduled for 2015. Proposition A is supported by a wide spectrum of UCSF faculty and staff and city politicians, as well as local community organizations, business groups and unions. Opponents of the bond measure say the project is “poorly planned” in part because the new hospital would sit between two old brick buildings that could crush the hospital in an earthquake. Opponents also argue that the project would add only 32 beds, which they say is an insufficient number to meet the future needs of the growing aging population. Opponents add that the project would be costly to property owners and renters alike. UCSF’s Ties to SFGH SFGH, which has partnered with UCSF since 1873, is a critical component of UCSF’s research, teaching and clinical mission at all four professional schools. About 1,400 UCSF faculty and staff work at SFGH, and another 600 UCSF employees work at SFGH-affiliated sites. In addition, about one-third of UCSF’s residents work at SFGH, making it an essential component of UCSF’s mission to train the next generation of physicians. Operated by the San Francisco Department of Public Health, SFGH is San Francisco’s only public safety-net hospital, treating more than 1,500 patients every day and nearly 100,000 patients every year. Located in the Mission District, SFGH provides nearly 20 percent of patient care services in the city, treating the homeless, working poor, uninsured and underinsured. Additionally, SFGH houses the city’s only level I trauma care center. In this role, SFGH must provide comprehensive care to injured patients 24 hours a day, seven days a week with its team of trauma surgeons, emergency medicine physicians, anesthesiologists, other specialists in a wide range of disciplines and highly trained nurses. “We are the only trauma hospital in the city and county and the incidence of trauma is increasing, especially in the aging population, due to falls and auto accidents,” says Sue Carlisle, MD, PhD, associate dean of the UCSF School of Medicine. “Our current Emergency Room [and Intensive Care Unit] facilities are already overcrowded.” Like many acute care hospitals across California, SFGH must comply with a state law by 2015 to better protect patients in case of an earthquake. SFGH is an aging facility; the existing acute care hospital building is over 30 years old. As Carlisle notes, building a new hospital would allow health care providers to meet the growing demand for emergency services. The Emergency Department at SFGH is one of the busiest in San Francisco, receiving the most ambulances of any emergency room in the city. Last fiscal year, SFGH tended to 52,000 emergency room visits. “The new hospital will have a greater capacity to handle a sicker population in that it will have more [Intensive Care Unit] beds and more flexibility in the use of many areas,” Carlisle says. “It also will have a larger, state-of-the-art ACE [Acute Care for the Elderly] Unit. With our aging population, we anticipate more demand for these kinds of specialty services. With the increased patient capacity, teaching becomes more efficient and can be better focused on best practices.” Essential Training Ground San Francisco resident Sam Hawgood, MB, BS, interim dean of the UCSF School of Medicine, is among those who believe it is critical to the University’s academic mission to rebuild SFGH. “The physician services and medical education that UCSF faculty provide at San Francisco General are a core of UCSF’s health care mission,” Hawgood says. “There is no better way for our trainees to learn how to address the diversity of medical needs in our community, and patients benefit because our faculty are able to apply lessons from UCSF’s latest research to patient care every day.” With an exceptionally diverse patient population, SFGH affords UCSF faculty and residents unique opportunities to develop culturally competent models of care. On any given day, about one-third of UCSF’s residents work at SFGH, making it an essential component of UCSF’s mission to train the next generation of physicians. Ricardo Muñoz, PhD, professor of psychology at UCSF and chief psychologist at SFGH, says a new SFGH will help attract talented faculty and students. “The reputation of UCSF as a world-class university, combined with the reputation of SFGH as a world-class public sector hospital, attracts physicians, psychologists and other health care professionals who are dedicated to serving the underserved, and who are committed to bringing the latest knowledge in health sciences to those who need it the most,” he says. ”We also address a major problem in the health research literature, which is that most clinical research in the past did not include low-income, nonwhite populations. The triple UCSF mission of clinical services, training and research adds very important elements to SFGH’s primary mandate to provide clinical services to the people of San Francisco. The combination of frontline services with cutting-edge science is hard to beat.” Carlisle agrees. “The commitment of the UCSF faculty to the mission of SFGH allows us to recruit and retain outstanding physicians,” she says. “Our training programs are nationally and internationally known for their excellence, and we will train many of the future leaders as well as many community physicians. Furthermore, the translational research efforts at SFGH have improved and will continue to improve medical care for all.” Indeed, the SFGH campus is home to more than 20 UCSF research centers, affiliated institutes and major laboratories. More than 160 UCSF principal investigators conduct research through programs, based at SFGH, with an annual budget of more than $140 million. These research activities support SFGH’s patient care by enabling SFGH to attract leading physician-scientists who provide patient care as well as pursue their research activities. The UCSF Strategic Plan, released in June 2007, recommends that the University should ensure that SFGH “continues to function as a major UCSF research site.” It states that “UCSF has an opportunity to take advantage of SFGH’s current research strengths and unique populations to develop SFGH into a clinical and translational research hub.” “We have numerous programs, such as malaria and AIDS prevention and treatment, that already have made a difference worldwide,” Carlisle says. “Also, our focus on underserved populations confronts many of the same issues that impact world health, including cross-cultural communication problems, access to health care, poverty and malnutrition.”