Special Joint Health and Planning Commission Meeting – May 11, 2023: CPMC Annual Compliance Review

This informational hearing was held jointly by the San Francisco Health Commission and Planning Commission on Thursday, May 11, 2023, at 10:15 AM. The sole agenda item was the review of California Pacific Medical Center’s (CPMC) Annual Compliance Statement for the 2021 reporting period, the ninth year of the development agreement (DA). City staff from Planning, the Health Service System, the Mayor’s Office of Economic and Workforce Development, and the Department of Public Health presented findings, and public comment was heard. The meeting concluded with a staff recommendation to find CPMC in compliance for 2021, though several commissioners raised concerns about ongoing obligations and community needs.

Public Comments & Testimony

• Billie Jean Wall (representing former CPMC warm‑water pool users): Described the long‑standing community aquatics exercise program at Davies and Pacific campuses, which she said was structured (not drop‑in) and provided critical therapy. She requested the program be restored.
• Dr. Teresa Palmer (former St. Luke’s physician): Urged a 10‑year extension of the monitoring agreement, stated that CPMC has a pattern of maximizing profitable short‑stay acute care while reducing less lucrative services for underserved populations. She cited the closure of labor and delivery at St. Luke’s without notice, discontinuation of the Davies warm‑pool low‑cost use, and lack of support for subacute beds. She argued the commission has stretched to find CPMC compliant.
• Gloria Rivera Since (community advocate): Highlighted the lack of hospital‑based subacute beds in San Francisco, forcing families to send loved ones out of county. She asked what steps the health commission is taking to ensure this care remains available.
• Melanie Grossman: Noted a pattern of service closures (Alzheimer’s unit, skilled nursing facility beds, warm‑water pool) and asked when the closure trend will stop.
• Tony Oriera: Supported Dr. Palmer’s call for a 10‑year extension, argued that CPMC should be found non‑compliant for the labor and delivery reduction without notice, and questioned the point of a development agreement with no penalties for non‑compliance.

Discussion Items

• Staff Presentation: Elizabeth Pearl (Planning) introduced the review. Key updates: CPMC completed construction of the Mission Bernal and Van Ness hospitals, made over $73 million in payments, and met most hiring and healthcare commitments. The City’s Health Service System reported CPMC in compliance on fee‑increase limits. Lowell Rice (OEWD) noted that 47% of entry‑level positions (48 hires out of 102 referrals) came from the First Source network, with 67% from priority neighborhoods and a 91% retention rate. Max Scarrow (DPH) reviewed healthcare provisions: CPMC exceeded charity care/Medi‑Cal patient counts (30,779) and community benefits ($16.5 million), continued participation in Medi‑Cal Managed Care, and maintained a partnership with NEMS for Tenderloin patients. However, labor and delivery services at Mission Bernal remained closed under a COVID waiver (without prior notice, found non‑compliant in 2020, but for 2021 DPH did not issue a new finding because the action occurred earlier). The Center for Excellence in Community Health (Health First) served 652 patients in 2021, below the target of ~800; the pandemic was cited. The Center for Excellence in Senior Health (ACE unit) exceeded its goal. CPMC reported that the warm‑water pool at Davies closed due to a broken pump and lift and is expected to reopen by end of August/early September 2023. On subacute beds, CPMC has not committed to financial support for new units but is open to discussions.
• Commissioner Questions and Comments:
  • Commissioner Bernal (Health): Asked about the 1,500 new Medi‑Cal enrollees in the Tenderloin. CPMC’s Kate Wyland explained that no new Managed Service Organization (MSO) was created before 2015, so the obligation lapsed; they continue to work with NEMS and St. Anthony’s. Only about 8% of the 4,593 NEMS patients were new in 2020. Commissioner Bernal urged CPMC to do more to serve the Tenderloin.
  • Commissioner Christian (Health): Questioned the lack of documentation for new Tenderloin patients and encouraged CPMC to increase services. On the warm‑water pool, CPMC’s Melissa White clarified it is a therapy pool (requires doctor’s order) and will reopen after repairs. Commissioner Christian urged CPMC to proactively address the subacute bed crisis.
  • Commissioner Gamero (Planning): Asked about the timeline for restoring labor and delivery at Mission Bernal. CPMC’s interim CEO stated they intend to reopen and will meet with DPH to plan a safe return, but no specific timeline was given. On the Center for Excellence, he noted the community advisory board is meeting again in person. Language services are currently only Spanish and English; he encouraged proactive expansion.
  • Commissioner Koppel (Planning): Praised construction compliance and the success of City Build and First Source programs in hiring from disadvantaged neighborhoods.
  • Commissioner Braun (Planning): Asked about the Guerrero Plaza improvements (part of the DA). Staff reported that the plaza design and permitting have been lengthy, but a substitution agreement has increased funding, and a permit application is in process with construction expected this year. On transportation demand management (TDM), she noted that only 18% of employees were enrolled in the transit subsidy in 2021; CPMC said they plan to hold transit fairs in November 2023 and are working to improve commute options. Commissioner Braun encouraged robust implementation.
  • Commissioner Diamond (Planning): Questioned the legal obligation to restore labor and delivery services. Staff noted that CPMC can reduce services with proper notice and meet‑and‑confer, but they did not provide notice in 2020. The city attorney said the health commission’s Prop Q authority is advisory only. Commissioner Diamond also raised concerns about the TDM goal (15% reduction in single‑occupancy vehicle trips by 2024) and whether the pandemic justifies an extension. She asked what happens if the goal is not met; staff said further measures would be required, but amendment would need Board of Supervisors approval.
  • Commissioner Chow (Health): Reflected on the history of the DA and the complexity of reopening OB services, noting patient safety, staffing, and declining birth rates. She commended CPMC for the improved cultural competency report (class standards) but urged more active engagement on subacute beds and a clearer process for the labor and delivery closure. She questioned why the 2021 compliance finding did not reflect the ongoing closure, since no change had occurred since the 2020 non‑compliance.
  • Commissioner Moore (Planning): Emphasized that the TDM plan is a continuous obligation and that the Cathedral Hill neighborhood has raised concerns about Clipper Card usage and transit mode share. She noted that the DA’s obligation to serve low‑income communities, especially in the Tenderloin, has consistently fallen short, and urged CPMC to embrace the spirit of the agreement as a nonprofit receiving tax relief.
  • Commissioner Imperial (Planning): Stressed the need for better data on barriers to community partnerships and asked whether SFMTA could impose additional fees if TDM goals are not met by 2024. SFMTA staff (Forest Chamberlain) said they will follow up but that no such fees have been discussed.
  • Commissioner Christian (Health): Requested a breakdown of construction hires by neighborhood (staff agreed to provide). She also urged CPMC to find temporary alternatives for the warm‑water pool users and to provide advance notice of service changes.

Key Outcomes

• Staff Recommendation: The directors of Planning and Public Health will determine compliance based on the hearing. Staff recommended finding CPMC in compliance for the 2021 reporting year, noting that most obligations were met or exceeded, but highlighting ongoing areas of concern: labor and delivery services at Mission Bernal, patient enrollment in Health First, culturally and linguistically appropriate services, and CPMC’s rate increases as a city health service provider.
• No Formal Vote: The hearing was informational; no motion or vote was taken by either commission.
• Next Steps: CPMC will meet with DPH to discuss safely reopening labor and delivery at Mission Bernal. The 2022 compliance report will be due soon, and at least one more joint hearing is expected before the DA expires in August 2023. Commissioners requested follow‑up on several issues: the legal basis for the 2021 compliance finding on labor and delivery, the status of TDM measures and the 2024 goal, data on new Medi‑Cal enrollees in the Tenderloin, and progress on subacute bed partnerships.