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Health commission hears Prop Q hearings on St. Marys cardiovascular surgery closure and Spine Center relocation
Summary
At a Proposition Q hearing, DPH staff said Saint Marys closure of its cardiovascular surgery program would be detrimental to the community; Saint Marys cited low surgical volume and plans for transfers and reassignment. Spine Center services are expected to continue under a private clinic pending Attorney General review.
Claire Lindsey, senior health planner for DPH, opened Proposition Q hearings on Saint Marys planned closure of its cardiovascular surgery program and the pending closure/relocation of its Spine Center. Lindsey said Saint Marys cardiovascular surgery averaged about 30—35 cases annually (compared with much higher volume at other area hospitals), that roughly 81% of those patients are San Francisco residents and that the service population skews older (85% over 60) and 47% Asian. DPH staff concluded the cardiovascular surgery closure would have a detrimental impact on the community and noted the item will be voted on Aug. 6.
Dr. David Klein, president and CEO of St. Francis and St. Marys, said the programs volume has declined from about 1,200 cases two decades ago to an expected 15 cardiac surgeries this year. He cited the national shift to minimally invasive approaches and fewer cardiothoracic surgeons, and said St. Marys plans to maintain other cardiac services (hybrid suites and cath lab) and transfer emergency or surgical cases to nearby hospitals including UCSF Parnassus and Mission Bay. Klein said he expects no reduction in FTEs for most staff and that the hospital could resume cardiac surgery in future should volumes change.
Commissioners pressed DPH and St. Marys for additional data: updated complication and outcome metrics (the most recent published was 2016), the breakdown of acute versus elective procedures, whether cardiologists and surgeons have privileges at receiving centers, and whether other hospitals have capacity to absorb transfers. Commissioners asked staff to provide requested data at the Aug. 6 hearing.
On the Spine Center, Lindsey said the SF Spine Group plans to move from a hospital-run clinic to a private office (average ~1,800 patients per year). The group has indicated it will keep payer contracts (including Medi-Cal) and emergency department call coverage; Saint Marys said the Spine Group expects to maintain the same services and volume, though the Attorney Generals review of the transaction (required by state law given the recent alignment between Dignity Health and Catholic Health Initiatives) may take about 90 days. Saint Marys reported five impacted administrative positions (two reassigned so far) and agreed to follow up with the commission on staffing outcomes.
The commission did not vote on either Prop Q item at this meeting; staff will return with additional data and a formal recommendation at the next hearing.
