It’s easy to see how transportation affects our health: most obviously in any crash or fall as we move about, more indirectly through pollution or social isolation caused by traffic and road design. But how does healthcare affect transportation?

The proposed closure by Sutter Health affiliate California Pacific Medical Center of acute-care services at St. Luke's Hospital “will have a devastating effect on the Bernal Heights, Mission, Potrero Hill, and South of Market neighborhoods,” said Paul P., a Bernal resident. “CPMC's notion that 85% of St. Luke's emergency department's patients could be handled by an urgent care center is ludicrous.” Patients forced to travel elsewhere face daunting distances and disconnected routes. Visiting family and friends could spend hours on transit.

Medi-Cal acknowledges the importance of transportation in healthcare accessibility. A 2002 paper from the Transportation and Land Use Coalition (TALC), Roadblocks to Health: Transportation Barriers for Healthy Communities, notes that “Medi-Cal regulations specify that primary healthcare services . . . should be no more than 30 minutes or 10 miles distance from each member's home.”

Public transportation from St. Luke's to the main CPMC campus in Pacific Heights would probably take twice that long. CPMC's Davies campus near the Castro is closer but no more convenient.

The proposed closure faces a wall of opposition from hospital staff, neighbors, health advocates, and local officials. “Closing St. Luke's as an acute-care hospital means getting sick or injured South of Market residents to any North of Market medical center will be a burden to the patient, the family, and the city's transportation system,” said San Francisco Health Commissioner Roma Guy.

Sutter Health has a poor reputation as a profit-hungry conglomerate indifferent to the needs of the communities it serves.

“The company's strategy has been to lure high-paying patients to its hospitals while closing or cutting services that serve the poor and mostly uninsured in lower income communities,” said Labor Notes, a Detroit-based monthly. “The head of San Francisco's public health department criticized the company on October 20 for attempting to leave only one acute-care facility [San Francisco General] open in the poorer neighborhoods in the city's south, while eight would remain in the more affluent north.”

More than half of St. Luke's patients come from the three closest zip codes, in what the hospital's own 2005 Community Benefit Report called a “federally designated medically underserved area.” Closure would exacerbate that designation. A 2006 study from the Journal of Health Economics found that “increased distance to the closest hospital increases deaths from heart attacks and unintentional injuries.” Another study from the Archives of Pediatric and Adolescent Medicine cited in the TALC report found that “Inadequate transportation to pediatric facilities in Boston was the largest barrier identified by Latinos when asked why they did not bring their children in for treatment or checkups.”

Half of St. Luke's patients have Medi-Cal, which is required to ensure “necessary transportation.” But, according to TALC, “Medi-Cal . . . defines eligibility for non-emergency medical transportation so tightly that only the physically disabled qualify. This narrow definition completely ignores the plight of transit-dependent individuals seeking healthcare.”

Residents from outlying areas will find access even more inconvenient than immediate neighbors. The San Francisco Bay View newspaper responded to CPMC's proposal in October, “Can you imagine someone with a heart attack in Bayview Hunters Point or the Excelsior trying to get across town in rush hour if SF General is not accepting ambulances, which happens often?”

Movement around the hospital is also an issue. St. Luke's is located at the convergence of several efforts to calm traffic and improve pedestrian and bicycle access. It has in the past acknowledged the impact of traffic on the community, donating $20,000 to the San Jose/Guerrero Coalition to Save Our Streets “to support the development of a neighborhood plan for pedestrian safety.” A 2005 hospital press release showed laudable understanding of the problem:

“The area surrounding St. Luke's Hospital has dangerous traffic conditions and driving patterns. Because of the hospital, and schools along San Jose/Guerrero, the area has an unusually slow-moving pedestrian population, made up of school-aged children, elderly individuals, hospital patients with various degrees of mobility and parents with young children. In contrast, the vehicle traffic along this corridor is unusually fast-moving, with drivers often racing along at twice the speed limit while passing and turning illegally.”

The hospital's status will have a concrete impact on its block. State seismic regulations dictate a substantial rebuild if St. Luke's remains an acute-care facility, offering an opportunity to redesign the bleak streetscape at Valencia and Cesar Chavez. If the buildings remain but services shift to nonacute care, CPMC can probably weasel out of making the substantial changes neighbors want.

“St. Luke's is the jewel of our neighborhood,” said Gillian Gillett, cochair of the San Jose/Guerrero Coalition. “We need to be more connected to it-more easily-and it to us.”

Fran Taylor can be reached at ftaylor@cmp.com or 415/947-6497. Full disclosure: her mother died in St. Luke's Hospital in 2001.

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