General Hospital Rebuild Bond DebateProposed Plan for General Hospital

We present the debate on Prop A - Both Pro and Con.

Yes on A

by Mitch Katz,
San Francisco public health director

San Francisco General Hospital, the city’s only trauma center and heart of our health care system, must be rebuilt to meet state seismic standards or close as early as 2013. The fate of General Hospital is something in which we all have a stake. Proposition A represents the most cost-effective way to finance this necessary and worthy civic endeavor.

Prop. A will authorize San Francisco to raise $887.4 million for a new acute care hospital building with an expanded emergency department and more room for patient care – and without raising your taxes. It’s endorsed by the Democratic, Republican and Green parties, the San Francisco Chronicle, Examiner and Bay Guardian newspapers, the Chamber of Commerce, Labor Council, Medical Society and Hospital Council, Senator Dianne Feinstein, Mayor Gavin Newsom and all 11 members of the Board of Supervisors.

The bond measure to rebuild is prudent and broadly supported because of the care that has gone into designing, planning and preparing the new hospital building and the financing program to pay for it. The rounded design – with two stories below ground and seven above – maximizes space for patient treatment and workplace safety, and is based on industry best practices. Pre-construction pricing and regulatory approvals were obtained to avoid cost increases due to delay. Careful scheduling means bonds for the new General Hospital will be issued as bonds for earlier projects are retired, resulting in no net increase in property taxes.

All of San Francisco has a direct interest in the mission of San Francisco General. As the city’s only Level One trauma center, General is solely prepared to respond to traumatic injury and multi-casualty accidents and other incidents, such as that which the city will face in the next major earthquake. It also delivers state-of-the art medical care to all, regardless of station in life, keeping faith with the values of our city’s namesake, Saint Francis of Assisi.

Staffed with physicians, surgeons and nurses affiliated with University of California San Francisco Medical School, General Hospital annually treats more than 100,000 people, receives more than 51,000 emergency room visits, including 29 percent of all ambulance traffic, performs more than 6,600 operations and delivers more than 1,200 babies. For more than a century, it has stood ready to respond to epidemic, most recently in the early 1980s when San Francisco General established the nation’s first AIDS ward. Through its partnership with UCSF Medical School, General Hospital is the training ground for new generations of medical professionals and a fount of research for the advancement of medicine. It simply must be maintained and kept open for the good of all San Franciscans and beyond.

Critics have suggested there are other sources of money to pay for the rebuild. There are not. In fact, the general obligation bonds that would be authorized by Prop. A are the least expensive form of financing. Other financing mechanisms would bleed resources from vital public services such as police, fire and parks. Others have suggested the current hospital could be retrofitted to meet seismic standards – but such a course would cost at least as much money and would result in less space for patient care while creating new obstacles to adapting to future medical technologies. Still others have suggested the city could build a cheaper hospital. But the proposed building was designed based on current and future patient demand and industry best practices. What’s more, delay begets cost increases – and threatens the very future of General Hospital.

The experiences of Californians elsewhere tell us the existence of public hospitals such as San Francisco General is not assured. Within the past 15 years, Sonoma, Fresno and Merced counties lost their public hospitals. Today, public hospitals operate in only 16 of 58 California counties. Generally, these hospitals were lost because of an inability or unwillingness of communities to support them at crucial points in their existence. We are at one of those crossroads in San Francisco.

To make the point, our campaign to pass Proposition A has introduce San Franciscans to people like rookie police officer Nick Ferrando, whose life was saved after a horrific traffic accident while responding to a crime scene, people like firefighter Dan Casey, who spent 13 days in General’s Intensive Care Unit, 10 days of it on life-support, after suffering smoke inhalation while responding to a warehouse fire, and people like school board Commissioner Norman Yee, who had his neck broken by a red-light runner while crossing a street and was put back together by the neurosurgeons at San Francisco General. If you or one of your loved ones suffers traumatic injury, you are going to want General Hospital standing ready.

The doctors and nurses of General Hospital save lives everyday. It is time for San Franciscans to save San Francisco General by voting Yes on Proposition A.

No on A

By George Wooding, VP West of Twin Peaks Central Council

The City of San Francisco is rapidly losing the trust of the San Francisco Voters.

Ask yourself, when was the last time San Francisco did a good job on a bond measure? How many Laguna Honda Hospital rebuilds do you want to be taxed for?

According to the 6/26/08 Civil Grand Jury report, “Accountability in San Francisco Government,” San Francisco’s bond measures are averaging between 35% to 67% in cost overruns. The Jury’s report documents horrendous City bond oversight, concluding: “The ultimate response to the lack of accountability and oversight is for the voters to demand better governance from City officials. In the meantime, there are no standard operating procedures to hold departments and commissions accountable [for bonds] and, by extension, no accountability by The Board of Supervisors, [the Controller], or the Mayor’s office.”

The City desperately needs sound financial bond oversight, yet has irresponsibly failed to adopt or apply any of the Civil Grand Jury’s bond oversight recommendations that were prepared in anticipation of the SFGH rebuild.

San Francisco charges the voters for steak and we always seem to end up eating hotdogs without a bun. Take a good look at this month’s $198.00 parcel tax increase in your property taxes. Proposition A’s $887.4 million cost is so expensive that San Franciscans can no longer afford to indulge the City’s “business as usual” cost overruns on bond projects.

The City has had 14 years to plan the SFGH rebuild and has waited until the absolute last moment to present the SFGH rebuild to the public. San Francisco is falsely claiming that SFGH will not be rebuilt if the voters fail to pass Proposition A. This claim by the City is an emotional, scare tactic designed to trick voters. SFGH will NOT be closing if Proposition A is not passed. A new law, SB306 will allow San Francisco to complete SFGH by 2020. Responsible City’s such as San Mateo finished the seismic retrofit of their hospital by 2002.

Many of Proposition A’s current design problems and cost overruns could have been avoided if San Francisco had been more responsible to its voters

What was the Department of Public Health (DPH) thinking when they spent $30 million planning Proposition A?

Construction is supposed to cost $887.4 million. By the City’s own admission construction may actually cost $943 million. This $55.6 million increase is open ended.

Furniture, fixtures and equipment (FFE) are supposed to cost $75 million. In 2006, Anshen and Allen’s SFGH feasibility study predicted that FFE would cost between $157 million and $234 million. It’s interesting to note that the price of medical equipment has dropped so dramatically, while the costs of everything else continues to rise.

The debt service on the bond is predicted to be $640 million. The sub-prime mortgage melt-down is paralyzing municipal government financing. San Francisco may face unprecedented delays in selling Proposition A bonds since the market for bonds has dried up. If the current economy conditions persist, the real story may simply be that the City will not be able to find buyer for it’s bonds. Incredibly, there is no cap on Proposition A’s bond interest rate and the bonds debt service may be underestimated by at least $100 million or more. Bond interest rates will certainly increase and debt service will skyrocket.

The recent history of inflation for California hospital construction between 2003 – 2006 of 18.5% should also make voters wonder why the SFGH rebuild is planning for only 7% annual cost increases.

Cost estimates to rebuild the hospital have already increased by 30% or $265.4 million in just two years. In 2006, San Francisco was planning to build a rectangular hospital for $622 million. The hospital being presented to the voters now is an oval, glass-walled structure featuring private rooms and $7 million worth of artwork. The less expensive rectangular hospital would have worked just as well, but may not have looked as nice. Just like the voters, San Francisco needs to start tightening its belt.

The City will also be spending hundreds of millions retrofitting the non-seismically retrofitted red brick buildings on the SFGH campus. Unfortunately, the new hospital will be located in the fall-zone of two of these antiquated buildings. San Francisco admits that the red brick buildings need to be retrofitted, but has arbitrarily decided not to retrofit the buildings until sometime after 2015. Voters can only wonder why the City is willing to risk the safety of the new $1.6 billion dollar hospital that we will be paying for over the next 23 years. Common sense dictates that he red brick buildings need to be retrofitted before the hospital is built, not after.

San Francisco needs to create an independent body, staffed by professionals dedicated to responsible bond planning and management. Voters can no longer trust the City to monitor themselves.

The City should also give the taxpayer a break by applying the available Tobacco Settlement Revenue (TSR) to the cost of the SFGH rebuild. By 2015, San Francisco will have earned $257.4 million in TSR funds. The City has already appropriated $148 million in TSR funds to finance replacing Laguna Honda Hospital, leaving the City with $109 million in TSR funds it could apply to rebuilding SFGH. The funds would help lower the cost of the SFGH rebuild to the voter. The City has never stated what they are going to use the TSR money for.

The City government has to do a better job representing the interests of the voters. Promises to voters must be kept, and voter’s tax dollars must be spent wisely and intelligently. San Francisco voters are kind-hearted and giving, but we can’t afford to see the City waste our tax dollars on another failed bond project. Let’s wait and fix Proposition A’s bond problems that the City’s irresponsibility to the voters has created. Before voting, ask yourself if you believe that the City has been responsible with the taxes they are currently spending. Without responsible governance and the required changes to the Proposition A bond: Vote No on Proposition A!