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Families and advocates press commission over CPMC subacute closures as DPH reports service transfers and IOA move
Summary
Public commenters and advocates told the Health Commission that transfers of subacute care out of county and staffing changes at CPMC have contributed to patient harm and deaths; DPH staff reported Institute on Aging has leased a Presidio site for Swindells day program and Sutter Pacific Medical Foundation says it hired bilingual diabetes educators and submitted letters of agreement to preserve coverage.
Public commenters urged the San Francisco Health Commission on Tuesday to take action after community members said recent transfers and staffing changes at California Pacific Medical Center (CPMC) have reduced local subacute care and endangered patients.
"How are 6 patients dead in less than 12 months?" asked Gloria Simpson, whose sister is a former subacute patient, during the public-comment period. Raquel Rivera described her sister's near-fatal pneumonia and said the family's regular check-ins likely saved her life. "My sister almost died," Rivera said. "We need to maintain hospital-based subacute care. We need experienced permanent staff."
The testimony followed presentations and questions about changes CPMC announced in 2018 under Proposition Q, the 1988 city measure that requires public notice before private hospitals reduce inpatient or outpatient services. Sneha Patel, DPH Policy and Planning, briefed the commission on three 2018 notices: a proposed licensure change for the Swindells Alzheimer's Day Program, the closure of a 24-bed Swindells residential care facility (which the commission previously found would be detrimental), and transfer of five outpatient service lines from CPMC to Sutter Pacific Medical Foundation (SPMF).
Patel told commissioners that the Institute on Aging (IOA) has signed a lease in the Presidio and expects to move the Swindells day program by July 2019; IOA estimates it can serve up to 88 people at the new site. Patel also said SPMF and CPMC have submitted about 240 letters of agreement (LOAs) intended to prevent loss of coverage for patients whose plans are not in the new provider network, and that SPMF reported hiring diabetes educators and an on-site medical assistant.
Dr. Kelvin Lam, CEO of Sutter Pacific Medical Foundation, answered commissioner questions about patient volumes and contracting. Lam said the foundation's data show patient volumes and payer mix have remained "pretty similar" before and after the transfer and that he believes LOAs have preserved access for many patients. He cautioned that some health plans declined to contract and that subcontracting restrictions sometimes prevent network arrangements without insurer approval.
Commissioners pressed for more quantitative context. One asked whether counts such as "85 patients per month" represented unique patients or visits; Lam said they were unique patients but agreed to provide further detail. Commissioners also requested comparative data on service levels before and after the transfers to be included in upcoming development agreement reporting so the commission can assess attrition, access and health impacts.
Advocacy groups, clinicians and family members argued the transfers have practical consequences beyond network paperwork. "To be moved to Fresno or San Jose is demoralizing," said Teresa Palmer, a retired geriatrician. Mark Aronson, with a community coalition, referenced a charity-care report and argued CPMC's contribution to care for low-income patients appears smaller than other hospitals.
The commission did not take a formal vote specific to CPMC on Tuesday. Commissioners praised IOA's progress on a Presidio location for the day program and directed staff to continue reporting back, including quantitative patient-volume and LOA details for the development agreement record.
What's next: Commissioners asked DPH to include more precise service-level data in future reports so they can determine whether transfers have led to patient attrition or reduced access and to monitor culturally and linguistically appropriate services for affected communities.
