Running on little to no sleep after working a night shift at the UCSF Parnassus Intensive Care Unit, Matthew Jones stood on the steps of City Hall Monday morning alongside fellow nurses and organizers from the California Nurses Association, who had gathered to demand answers from UCSF regarding its acquisition of St. Mary’s Medical Center and Saint Francis Memorial Hospital.
When it was his turn to speak, Jones had an ominous message:
“When UCSF took over [Benioff Children’s Hospital Oakland] in 2014, they hollowed it out from within. We cannot let this happen at Saint Francis and St. Mary’s,” Jones warned.
Other nurses at the rally of around 30 people—some from UCSF like Jones, many from St. Mary’s and Saint Francis, and a handful from the Children’s Hospital—remember when CHO lost specialty services like the Tuberous Sclerosis Clinic in 2020, which saw patients move to the Stanford hospital system or lose access to care entirely.
Like CHO, St. Mary’s and Saint Francis also offer highly specialized medical facilities, including St. Mary’s Adolescent Psychiatric Services and the Bothin Burn Center at Saint Francis, which is the largest burn center in Northern California.
They also currently serve some of the city’s most vulnerable communities, including residents in the Tenderloin, unhoused people, and those with severe psychiatric and mental health needs.
Combined, the hospitals offer about 50 percent of San Francisco’s emergency psychiatric services, 42 percent of inpatient rehab services, and invest more than $11 million a year into charitable care available to low-income patients.
So what exactly will happen to St. Mary’s and Saint Francis hospitals when UCSF absorbs them at the end of June this year?
Despite constant requests to UCSF for information, the nurses say they’ve been met with total silence.
“My first question to UCSF: What are you hiding? What are you afraid of telling us?” demanded a St. Mary’s nurse who identified herself only as April.
The nurses were about to get some answers: An hour after the rally, the group, all wearing CNA red, filed up the grand staircase of City Hall and into a meeting room, where District 11 Supervisor Ahsha Safaí had called a hearing of the Rules Committee to address the nurses’ worries.
Shay Strachan, UCSF Health’s chief partnership and growth officer, approached the podium and addressed one of the nurses’ most pressing concerns: No mass layoffs were on the horizon.
“No nurses, no staff—period—will lose their jobs as a result of this transaction,” Strachan said.
Strachan went on to detail out UCSF Health’s plan to “retain and grow” both staff and services at the two soon-to-be-acquired hospitals. She also briefly addressed how the organization would be structured post-acquisition, which was a vocal concern of Amy Preble, an RN and chief nurse representative at St. Mary’s.
Preble said that she’d heard UCSF will become the owners, while the two community hospitals will technically remain separate entities. Preble said she believes this only serves to further disenfranchise both the employees and patients, which should be “as alarming to the community as it is to the staff.”
According to Strachan’s presentation, St. Mary’s and Saint Francis will both become “licensed hospitals” under UCSF Health and will be renamed to UCSF Health St. Mary’s Hospital and UCSF Health Saint Francis Hospital. How exactly this will impact the distribution of funds, facilities, and services is still unclear.
Strachan also underscored the anticipated growth of reproductive and gender-affirming healthcare services, since a UCSF acquisition means St. Mary’s and Saint Francis will no longer be officially Catholic organizations.
But the nurses say, while that’s all well and good, they’re not totally convinced UCSF will put their money where their mouth is when the time comes to “retain and grow” current services, let alone implement new ones. Nurse Rachel Cohen Cepeda, who has worked in UCSF’s psychiatric unit since 1998, said UCSF only recently came off its second hiring freeze since 2020 due to what the administration told the nurses were financial constraints.
“We’re short-staffed every day, below legal guidelines, and UCSF says they can’t afford to hire new nurses. But then they go and buy two whole hospitals? It just doesn’t add up,” Cepeda said.
Cepeda said she doesn’t think UCSF is a victim of the nursing shortage—she thinks it’s responsible for it. She says that, in short, UCSF buys hospitals, eliminates vital nursing positions, and then goes on hiring freezes so there’s no chance to fill even the positions that remain.
“The system is trying to profit off of patients’ suffering, and we’re suffering with them.”
Cepeda admits she’s cynical, but she’s certainly not alone.
“I mean, it’s a business, it’s a corporation. There’s just no way they’re doing this without an ulterior motive,” said Yvette Bassett, a registered nurse at Saint Francis. “Basically, Stanford wants a monopoly in the South Bay, and UCSF wants the North.”
But the northern part of the Bay Area, let alone San Francisco, is no medical monolith. Throughout the hearing, Safaí and the public commenters from the CNA rally emphasized that even if all the services currently offered by Saint Francis and St. Mary’s are indeed maintained, moving facilities around the city to places where patients in need might not be able to access them would hurt the populations they serve now.
Safaí dug into the issue of equity, using the CHO acquisition as a chilling example, when examining the UCSF rep.
“I don’t need to tell anyone in the room that the population these hospitals serve is overwhelmingly BIPOC,” Safaí said. “What do you say to the feelings of systemic racism in that [CHO] acquisition?”
“I can’t speak to any reports of systemic racism, but I can speak to UCSF’s values,” Strachan replied. “We take diversity, equity, and inclusion very seriously.”
Safaí also pressed for a city-run plan to ensure the “UC takeover” didn’t end up damaging to the vulnerable populations St. Mary’s and Saint Francis serve. Claire Altman, the senior health program planner from the Office of Policy and Planning at the Department of Public Health, said that her office will gather reports on the impact of the acquisition every six months. But if those reports do show detrimental results? How the city would respond is an open question.
After the hearing, Cepeda called the whole testimony nothing but “lip service.”
“In terms of boots on the ground, I didn’t get the answers I needed.”
