Everyone's hospital

SF General — a top trauma center, important safety net, and major city commitment to public health — moves into an uncertain transition period

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Guardian illustration by Matthew Fleming

rebecca@sfbg.com

"I am a survivor of the AIDS epidemic," Daniel volunteered, beginning to tell us his very San Francisco story.

He was diagnosed with HIV in the 1980s. Working in fine dining rooms of San Francisco hotels at the time, he had health insurance, and had gone to Kaiser for an unrelated procedure. That led to a blood test — and then wham.

"They just bluntly, without any compassion, just told me: You have it," Daniel said. "Like telling you that you have a pimple on your nose or something."

All around him, friends were dying from the disease. "I didn't freak out, because that's just my personality," he recalled. "I know a lot of people who have been diagnosed, and they want to take their lives or whatever."

Today, he's unemployed and living on a fixed income. He lost his left eye years ago to an infection linked to HIV; he now has a prosthetic eye.

"I'm single, disabled, and low-income," reflected Daniel, who didn't want his last name printed due to privacy concerns. Originally from El Salvador, his family came to the U.S. when he was 10 and Daniel has permanent resident status. But despite the disadvantages he faces, Daniel still isn't freaking out. His medical needs are met.

He got on MediCal after having to drop Kaiser. "And then I ended up at SF General," he said, "with some of the most professional staff, doctors rated worldwide. It has some of the most professional health care providers for HIV, all in one place."

Daniel is one satisfied San Francisco General Hospital patient, and he might as well be a poster child for how public health is supposed to work in big cities. Rather than being deprived of primary care and then showing up at the emergency room with preventable complications stemming from his disease, he's keeping everything in check with regular doctor's visits — and he can access this high level of care even though he's on a very tight budget.

There's a concerted effort underway in the San Francisco Department of Public Health to give more patients precisely the kind of experience Daniel has had, while also expanding its role as the region's go-to trauma center.

But a difficult and uncertain road lies ahead of that destination, shaped in part by federal health care reform. The new course is being charted amid looming financial uncertainty and with more patients expected to enter the system and the doors of SF General.

Not every General Hospital patient is as lucky as Daniel. For scores of others, SF General is the last stop after a long, rough ride.

 

EMERGENCY CARE

Craig Gordon and Dan Goepel drive an ambulance for the San Francisco Fire Department, regularly charging through congested city streets with sirens blaring as they rush patients to SF General and other care facilities. They see it all: Patients who are violent and psychotic and need to be restrained in the back of the ambulance, folks who've just suffered burns or gunshot wounds.

Sometimes, in the thick of all of this, SF General's Emergency Department is closed to ambulances — in public safety lingo, it's called being "on diversion" — so the medics will have to reroute to different hospitals.

SF General might go on diversion because the Emergency Department is too slammed to take on anyone new, or because it's too short-staffed to take on new patients without pushing nurse-to-patient ratios to unsafe levels.

For serious trauma cases, strokes, heart attacks, or traumatic brain injuries, however, the doors are always open. Patients with less-serious cases are the ones to be turned away when the hospital is on diversion.

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