First Appeared Friday, 10 February '06

SF General and UCSF: Partners in Public Health

Exemplifying virtue and value, San Francisco General Hospital (SFGH) is both literally and figuratively a hospital with a heart.

Nestled at the foot of Potrero Hill in the city’s Mission District, the public hospital has been an essential part of San Francisco’s health care system since 1872. Considered one of the finest public hospitals in the US, the General, as many refer to it, offers humanistic, cost-effective and culturally competent care to an international community of patients regardless of their ability to pay. This history has had a strong impact on the hospital’s culture and creed.

“People who work here are passionate about what they do,” says Sue Carlisle, associate dean in the University of California, San Francisco (UCSF) School of Medicine at SFGH. “They work here because they are dedicated to taking care of patients.”

Sue Carlisle

For the past 133 years, SFGH has been a partner in public health with UCSF. The University provides faculty from all four schools — dentistry, medicine, nursing and pharmacy — who provide patient care services, conduct research and teach at SFGH. The UCSF School of Medicine has launched a new website devoted exclusively to SFGH.

Most UCSF faculty based at SFGH are from the medical school, but important work is being done by the others schools. Their contributions include:

• • The School of Dentistry operates the UCSF Oral and Maxillofacial Surgery Clinic, which provides inpatient and outpatient services such as trauma surgery for the jaw and facial bone fractures, surgical correction of maxillofacial skeletal and soft tissue deformities and diagnosis and disease.
• • The School of Nursing offers a nurse-midwifery education program that has graduated hundreds of nurse-midwives and has provided more than 12,000 women with midwifery care for their births, about half of which are at SFGH.
• • The School of Pharmacy manages the California Poison Control Center, which consists of four answering sites, including SFGH. The school’s Betty Dong also regularly works with a multidisciplinary team of pharmacists, physicians and nurse practitioners to answer calls to the National HIV Telephone Consultation Service and the National Clinicians Hotline.

Social Responsibility
As the City and County of San Francisco’s acute care hospital, SFGH is the primary provider of safety-net health care for the most vulnerable — the poor, uninsured working families, immigrants and the elderly. About 80 percent of its patient population either receives publicly funded health insurance (Medicare or Medi-Cal) or is uninsured. The number of uninsured people in San Francisco has climbed to 150,000 — all of whom are welcome at the public hospital. SFGH also cares for the homeless, who make up about 8 percent of its patients.

“There are so many things woven into the fabric of the values of this hospital that I forget it’s not that way everywhere else,” says Susan Scheidt, who works in psychosocial medicine.

SFGH is known for its patient-centered care and communication — efforts recently honored by the American Medical Association. It excels in reducing the financial, linguistic, cultural, physical and operational barriers to health care. Among its many patient-friendly features are staff who are trained and tested to interpret 20 different languages, an advocacy office located in the lobby that helps patients navigate the hospital, and an immigrant and refugee clinic that houses the Newcomers Health Program to provide access to health care.

SPECIAL SFGH REPORT Working to Fill AIDS Treatment Gap in Uganda Teresa Villela: Practicing True Family Medicine Staph Sleuth Detects, Dissects and Protects Treating Asthma, Improving Lives Defining Essential Elements of TB Care Q & A With SFGH Chief of Staff Diane Havlir: Driving Science, Patient Care in HIV/AIDS Psychiatric Emergency Services: A Safety Net Catching Those in Crisis

“It’s not enough to speak the language and be culturally appropriate; you must also build trust,” says Maria Jose Herrera, who works for the smoking cessation program launched in 1987 to help the Latino community.

Building trust takes time. On a recent Wednesday morning, community health worker Sylvia Raymundo spent more than 20 minutes talking with a mother and her son about treatment options in the Pediatric Asthma Clinic.

SFGH is open to innovation and ideas that break the mold and set new standards for a public hospital. “If you have the energy and time commitment to do something, people will allow you to do it,” says Gene O’Connell, executive administrator at SFGH.

When Bill Schecter, chief of surgery at SFGH, saw the need to provide outpatient surgeries for the low-income residents who otherwise would not be able to afford them, he co-founded Operation Access in 1993. He and other staff members work weekends alongside students and residents who volunteer for this program. Operation Access is now a Bay Area-wide organization. For this public service, Schecter has won the American Medical Association's 2006 Pride in the Profession Award. Similarly, when infectious disease epidemiologist David Bangsberg saw that HIV-positive Ugandans couldn’t afford the drug regimen, he started the Family Treatment Fund to provide them with antiretroviral treatment.

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