Op-ed: The politics of hospital closures

Despite its summer resolution opposing the closure of Alta Bates Hospital, the City Council’s failure to plan for the medical needs of Berkeley rests squarely upon the shoulders of its majority members and their appointees to the Planning Commission and Zoning Adjustments Board.

Planning and zoning are fundamental obligations and powers of government. However, the Bates-dominated council abdicated these responsibilities when it rezoned the Herrick Hospital site without any serious thought as to what this might mean to the future of Berkeley’s medical needs. What follows is the back story. It is offered to those who have who have forgotten (or do not know) how a city of 114,000 inhabitants astride a fault-line faces the loss of medical services that are fundamental to its long-term health, safety and viability.

The seismic shortcomings of both Alta Bates and Herrick Hospitals are longstanding. Still, land that is zoned for hospitals should not be rezoned without, first, planning for the medical needs of Berkeley’s citizens and determining that these sites are no longer necessary. This did not happen during the Downtown Area Plan Planning Process (DAP). It is possible that the Council’s response offers too little, too late to correct the situation.

During the DAP process, the Bates majority had the opportunity to anticipate and plan for the medical needs of the city. They rejected this chance when, knowingly, they approved an Environmental Impact Report (EIR) which decoupled the relationship between the city’s two medical facilities, rezoned the Herrick campus and its associated parcels, and removed a provision from the plan that would have required the city to engage in a healthcare planning process before any zoning change was made to the Herrick campus.

Facing similar issues, and recognizing the need for a coherent medical infrastructure, the San Francisco Planning Commission did not delegate the planning of its medical services to market-oriented institutions. In contrast to Berkeley, the SF Planning Commission froze all hospital-related planning and construction and developed a comprehensive plan to inform its decision making. At the time, Sutter sought the closure of St. Luke’s Hospital in the Mission. Following the successful conclusion of this planning process, St. Luke’s was rebuilt and Sutter modified its plans for the Cathedral Hill facility. It is worth noting that Sutter has asserted the need to close Alta Bates because of the inefficiency of operating two emergency rooms within three miles of each other. Yet, St. Luke’s and SF General are barely one mile apart. At its core, effective planning is rooted in the needs of populations.

During the DAP process, I spoke with Dan Marks, then Berkeley’s Director of Planning, and raised these concerns with him directly. He replied: “If I allow your issue to be considered, I will lose control of the entire process to every other special interest in the city.” When did a concern for the medical needs of a population become a “special interest”? And, how is it that the special interests of the developer community became the general interest? In the end, the EIR ignored the question of what would happen were there no hospital in Berkeley’s earthquake-prone future. Instead, the EIR limited itself to the problem of a small increase in the downtown population.

Thus, where a significant impact would exist if there were a reduction in the availability of facilities and services that could adversely affect human health or safety of the entire city, the EIR concluded: “Although the City of Berkeley has no formal methodology to evaluate the adequacy of health and human services, the additional population in the Downtown Area would not be likely to require new health/human services facilities or expansion of existing human/health services of existing human health services facilities, and the DAP-related impact would be less than significant.” (Emphasis my own.)

The logic of the DAP’s EIR is deeply troubling because the needed analytical capabilities do exist, and they existed at the time. It is not credible that Berkeley, a city with its own health department and a School of Public Health in its midst, cannot assess the medical needs of its citizens. The Bates council majority failed in its responsibilities when it certified the EIR for the DAP as adequate. It also failed to exercise its responsibilities to ensure guidance and oversight of staff that would ensure the integrity of the decision-making process. In doing so, it knowingly jeopardized the future of Berkeley’s medical infrastructure and safety.

It will take serious courage and hard work on the part of truly progressive candidates to correct this situation. Those responsible for creating it should not be rewarded via promotion or return to office.

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Daniel Caraco, a 50-year Berkeley resident, holds an MPH in Health Policy and Planning from UC Berkeley and has worked for the National Health Service in the UK.