Health director lays out SFGH rebuild plan, estimates $622M base cost and three escalation scenarios

Dr. Mitch Katz, director of public health for the city and county, told the Government Audit and Oversight Committee that the San Francisco General Hospital (SFGH) rebuild is driven by state seismic law and that the county cannot continue to operate without a seismically compliant acute-care trauma center.

"San Francisco General is the only acute care hospital, run by the county, the only trauma center," Katz said, noting the hospital handles roughly half of the city's ambulance drop-offs and more than 100,000 acute-care days annually. "We couldn't possibly in San Francisco survive on a day to day basis, let alone in an emergency, were this hospital closed." (Dr. Mitch Katz)

Katz reviewed three earlier site approaches that were rejected — building on the 20 Third Street parking lot (which would place emergency activity directly adjacent to residences), demolishing usable hospital buildings (Buildings M and A100) to rebuild elsewhere, and building on the front lawn at the expense of historic Victorian structures. He described an alternative design that uses an underground "super floor," allowing structural support below grade while preserving a 40-foot separation above grade to protect historic buildings and remain within zoning restrictions.

Katz also emphasized neighborhood impacts and operational improvements. The plan would shift ambulance access away from 20 Third Street — which runs by residences — to 20 Second Street, a route that passes campus buildings rather than homes, "so we will have much less disruption to our neighbors," he said.

On costs, Katz provided scenario-based estimates rather than a single figure. "If you look at the cost, 622, almost 623,000,000 for the building and design," he said. He added that FF&E (facilities, fixtures and equipment) is estimated at about $157.9 million and that the plan yields "a cost per bed of 2,700,000.0, assuming 230 beds." Katz described three escalation scenarios: a base case (8% first year, 6% thereafter), a mid case (10% first year, 8% thereafter) accounting for modest delays, and a high case (12% then 10%) that could push the total substantially higher.

Katz said the department is proceeding as if a bond had passed and has roughly two years of preparatory funds for engineering, soil sampling and EIR work; he said a bond measure would likely need to go before voters in February 2008 to keep the project on schedule. He also warned that state plan review by OSHPD is lengthy (about 2½ years) and noted a bill on the governor's desk intended to extend the SB 1953 compliance deadline from 2013 to 2015.

The presentation concluded with public engagement steps: Katz said the Health Commission would hear the report at public meetings on October 3 (3 p.m., 101 Grove) and October 5 (auditorium), and staff invited public comment on the rebuild approach. A union representative, Ed Vorshower of SEIU Local 790, said he supported the plan but urged clarity on bed-count assumptions (noting a prior blue-ribbon group's 267-bed figure) and on SNF continuity.

The committee agreed to continue the item to the call of the chair for further process and public engagement.

The next procedural step Katz identified is Health Commission hearings and, subsequently, voter consideration of a bond if the city chooses to proceed.