Commentary: Parking Over Patients in New St. Luke’s Hospital Plan

St. Luke's Streetscape Plan

St. Luke's Streetscape Plan

Fran Taylor contributes occasionally to Streetsblog San Francisco and wrote this Op-Ed on the CPMC plans for rebuilding the St. Luke’s Hospital in the Mission near where she lives.

An ambitious plan to overhaul hospital operations throughout the California Pacific Medical Center (CPMC)/Sutter system in San Francisco has stirred up controversy on a number of fronts. Neighbors of a proposed 555-bed facility on Van Ness and Geary fear out-of-scale development and are already facing evictions. Nurses embroiled in a long-running labor dispute with CPMC worry that the plan would squeeze out union jobs. Patient advocates decry the loss of neighborhood services, including psychiatric and skilled nursing facility beds.

It’s hard to digest the whole massive proposal, but because I live in the Mission and have advocated for several years on pedestrian, transit, and bicycle issues along the Cesar Chavez corridor, I naturally zeroed in on the plan [pdf] for St. Luke’s Hospital at the corner of Cesar Chavez and Valencia.

Priorities quickly emerge from the DEIR regarding health care and transportation at St. Luke’s. The current hospital campus has a parking garage at Duncan Street with 215 spaces, and this will remain basically unchanged in the new design. Elsewhere on the campus, a little over 100 other parking spaces currently exist, mostly in a surface lot that is the site of the proposed new hospital. The hospital building to be torn down and replaced, on the corner of Cesar Chavez and Valencia, now has 229 beds. In the CPMC plan, a replacement hospital would offer only 80 beds, while a new medical office building to be constructed on the site of the current hospital would include a new parking garage with 220 spaces. So the plan proposes basically a mirror flip: from about 200 to 80 patients, from about 100 to over 200 cars.

The five-level garage would have in and out ramps on both Cesar Chavez and Valencia streets. Valencia already has a busy bike lane, and Cesar Chavez is slated for major streetscape improvements early next year that will include bike lanes from Guerrero to Hampshire.

The DEIR itself notes that cyclists will suffer but offers few ideas for mitigation: “The proposed passenger loading/unloading zone and off-street loading area for the Replacement Hospital on Cesar Chavez Street would create a new conflict point between loading activities, vehicles, and bicyclists on Cesar Chavez Street. Vehicle/bicycle/pedestrian conflicts would be similar to those that occur at the existing passenger loading/unloading zone adjacent to the existing hospital on Valencia Street, although on Valencia Street traffic volumes are lower and bicycle volumes are higher than they would be on Cesar Chavez Street with the noted improvements. The new parking garage access on Valencia Street and new project-generated vehicle trips to this facility would result in increased vehicle/bicycle conflicts on a street that is designed to facilitate bicycle travel.”

The proposed mitigations consist of signals to alert motorists departing from the garage of the presence of cyclists and pedestrians, painted bike lanes, and audible warnings to pedestrians and cyclists telling them that a car is exiting.

CPMC takes greater measures to deal with potential parking shortfalls, including leasing 400 spaces in the Japan Center garage and 180 spaces at another garage at 855 Geary and running shuttle buses to both garages. The citywide shuttle system is touted as a means to reduce auto traffic and provide an alternative to Muni for patients, visitors and staff. The shuttles, however, run only northwards from St. Luke’s to the other CPMC campuses and the garages mentioned, while many patients and their families come from neighborhoods to the south: Outer Mission, Excelsior, Bayview. St. Luke’s is the only hospital other than San Francisco General to serve southeastern San Francisco.

“Last time I checked, about 80 percent of St. Luke’s patients arrive by private automobile,” said Gillian Gillett, an immediate neighbor of the hospital. “The neighborhoods currently served by St. Luke’s are poorly served by reliable public transit.”

Clearly, people traveling to a hospital because they’re sick, injured, or otherwise incapacitated are not likely to jump on a bicycle or walk long distances to get there. They may even be unable to deal with long waits and lurching rides on public transportation. But staff and visitors tend to be more mobile and open to alternatives. Like the Kaiser system and San Francisco General Hospital, CPMC does run one shuttle to BART, and that route has the highest ridership of any of the various lines, demonstrating potential demand if access were expanded.

What’s particularly frustrating about these changes to the streetscape environment is that they’re taking place in the context of reduced patient care. Though the new hospital is proposed to be about 145,000 square feet, compared with 197,983 square feet for the current building, or about three-quarters the size, the number of patients it will care for will be only about one-third of the previous total. Completely eliminating the skilled nursing facility (SNF, or “sniff”) at St. Luke’s will hamper the city’s ability to care for a growing senior population, even as other facilities such as Laguna Honda downsize. According to a 2009 report [pdf], the City faces a 30 percent shortage of SNF beds in the next 10 years. Cuts in psychiatric services, another rising need, are also a concern.

CPMC states that St. Luke’s already has empty beds, and it’s true the census rarely rises to capacity, but the conglomerate also performs poorly in its legally required commitment to charity care, and potential patients have long faced uncertainty about which services are available.

Neighbors have been haggling over the St. Luke’s proposals for almost two years, since early designs were released. Those living closest have expressed alarm at the prospect of the new hospital being built on the site of a surface parking lot close to Guerrero and their rear windows, after already having lost their backyards in the 1950s when Guerrero was widened as part of the proposed Mission Freeway plans. Immediate neighbors think the current hospital should be closed and demolished first so the replacement structure could be placed in the current location on the corner of Valencia.

But staff, patient advocates, and other neighbors consider a closure of several years unacceptable. A Blue Ribbon Panel formed when St. Luke’s came close to being shut down altogether some years back, the Health Commission, and the Board of Supervisors also oppose such a closure.

Shannon Dodge lives near the 101 freeway maze and a few doors from Cesar Chavez, which she has been working to calm. She recently had a baby at St. Luke’s. “As a neighbor, cyclist, and mom of a three-month-old St. Luke’s baby, I’d want to know whether CPMC has an aggressive transportation demand management program at St. Luke’s,” she said. “That means attractive incentives for staff to carpool, ride the bus, bike, or walk to work, much like the incentives that are successful at other large institutions. If the proposed 200-space garage is sized in the absence of such a program, it’s too big. Should this garage go forward, it must be designed to minimize car traffic on popular bike routes.”

Gillian Gillett has other worries. “I am more concerned that the use of the land where the current hospital stands will become a surface parking lot and ‘tree farm’ until there is a need to build more capacity at St. Luke’s,” she said. “The end of Phase I will bring the tower down and repurpose that site into an empty lot until there is sufficient demand to build something there, leaving the intersection of Cesar Chavez and Valencia three-quarters surface-level parking lots.”

Gillett’s organization, the San Jose/Guerrero Coalition to Save Our Streets, has come up with an alternative plan.

The lack of a united response has played into the hands of CPMC, which is also trying to whipsaw the various affected neighborhoods. But some Cathedral Hill residents have joined a healthcare advocacy group that also includes residents from the area served by St. Luke’s to pound home the issue of equity: Why should one neighborhood get a mammoth 555-bed facility, while another gets 80 beds?

“The DEIR concludes that the environmentally superior alternative is a bigger St Luke’s and a smaller Cathedral Hill,” said Nato Green, labor representative for the California Nurses Association and spokesperson with the Coalition for Health Planning, a group that formed to fight the CPMC plans. “CPMC has yet to produce a shred of evidence to support their pie-in-the-sky claims of better health care from concentration of services at Cathedral Hill.”

It doesn’t have to be this way. When San Francisco General Hospital faced massive disruption during the seismic rebuild of its hospital, a Transportation Demand Management office created a year before construction was to begin surveyed staff and visitors and came up with a long list of mitigations to deal with traffic. The moves are just a continuation of SFGH’s ongoing push to reduce the number of workers who drive alone. Those percentages have been going down as a result, and the hospital sees its promotion of cycling, walking, and transit as part of its mission to improve public health. Unlike St. Luke’s, where physicians park for free, staff who park on campus pay $120/month or $100/month to park in the nearby garage. While the crazy hours and stress of medical care naturally make it tempting for workers to opt for the fastest commute option, the public hospital puts its money where its mouth is by charging for the privilege. Transportation advocates could push CPMC/Sutter to show that it cares at least as much for patients as for parking.

CPMC disputed charges that it plans to eviscerate patient care and endanger cyclists and pedestrians at St. Luke’s. Geoffrey Nelson, the director of enterprise development for CPMC and head of long-range physical planning, said the St. Luke’s transportation demand management program will take inspiration from CPMC’s Davies facility, where 45 percent of people travel there by alternative modes (i.e. not alone in a car).

“I think this project will be, urbanistically, and from the point of view of community life, the best thing to happen to this neighborhood in decades,” he wrote me in an email.

The project will produce a much more engaging, safe, active, and attractive Cesar Chavez frontage, a wonderful new multilevel pedestrian plaza connecting the lower grade at Cesar Chavez with the upper grade at San Jose and 27th Streets, and clear wayfinding and inviting entries and spaces for the community.

The replacement hospital will increase patient volume by over 20 percent. Beyond this, a new Medical Office Building (the building with the subgrade parking structure) will bring additional physicians and services to the campus. Most medical care (over 80 percent) that you and I will receive in our lives will be delivered somewhere other than a hospital, such as in a multi-specialty clinic like we’re proposing. Medical activity will increase markedly on the campus [pdf].

Critics remain skeptical, however, and they have a long history with CPMC that informs their distrust. When CPMC was threatening to close St. Luke’s, neighbors, staff, patients, and politicians rallied to save it. Transportation advocates could push CPMC/Sutter to show that it cares at least as much for patients as for parking.

A new group, the Coalition for Health Planning, has formed to fight the current CPMC citywide plan. Labor, Democratic clubs, and community groups from the Gray Panthers and Coleman Advocates for Children & Youth to the Day Labor Program, along with neighborhood associations such as the Bernal Heights Neighborhood Center and Cathedral Hill Neighbors Association, are well represented. Conspicuously missing, however, are any transportation or sustainable streets organizations.

Public comments will be accepted until 5:00 p.m. on Wednesday, September 29. Written comments should be addressed to Bill Wycko, Environmental Review Officer, San Francisco Planning Department, 1650 Mission Street, Suite 400, San Francisco, CA 94103, or sent by e-mail to Chelsea.Fordham@sfgov.org or Devyani.Jain@sfgov.org. If you have any questions, please contact Devyani Jain at 575-9051 or Devyani.Jain@sfgov.org.