Today is the last day of a decades-old rehabilitation program for heart patients at California Pacific Medical Center in San Francisco.
A group of about 70 patients, many of them elderly, demonstrated outside the hospital at Buchanan and Clay streets Wednesday to protest the termination of the program designed to promote health in patients with heart problems.
The program, known as Phase III, is the final stage of rehabilitation for patients who have had "cardiac events," like a heart attack. In Phase I, specialists assess patients in the hospital. Phase II, beginning after a patient has been discharged, involves 24 to 36 weeks of a health regimen that includes exercise, nutritional training and even counseling. Phase III is an ongoing exercise regimen that doctors recommend in order to maintain heart health.
Phase III patients use exercise equipment like a treadmill or bicycle in the hospital gym, but they can also avail themselves of nurses and exercise physiologists, as well as an EKG monitor that sends information directly to a nurses’ station. The classes are not covered by insurance, and patients pay out of pocket for them, about $14 to $17 per class. Phase I and Phase II are covered by insurance.
The are about 180 patients enrolled, according to hospital spokeswoman Kathie Graham, although not all participate. The patients range in age from their 50s to 90s, with occasional younger patients mixed in. Many have been coming for several years.
Graham said that while Phase III patients can take advantage of nurses, exercise physiologists and monitoring equipment, it is not a required part of their program. Those tools are present to accommodate the Phase II patients, who attend the same classes.
Graham said it was a tough decision to cut the program, but that the hospital wanted to focus on getting more patients to participate in Phase II and expand it to include other types of patients, like those with lung disease.
Patients received letters from the hospital dated Aug. 16 informing them that the class was being cut, and would end today. The letters included a list of alternatives to the program, including fitness classes offered by the hospital and addresses for local gyms, like the YMCA.
But patients say those just aren’t good enough.
Allen Grossman, 85, who has been going to the program for three years, says that he frequently uses the heart and blood pressure monitoring as well as the advice of nurses and exercise physiologists.
“What I can’t replicate is the ability to talk to those nurses,” Grossman said. “I have edema, an accumulation of water in your system, and it’s not good for the heart. I wouldn’t have known about it unless I talked to one of the nurses and she told me to go see my cardiologist. Who will I ask at the Y?”
At 45, Robert Prestidge is one of the rare younger patients in the program. He had a heart attack when he was 42 and says it was a life-changing experience. He stopped smoking and started exercising. He gets up at 5 a.m. to attend a 7:15 a.m. Phase III class before going to work.
While he agrees that the option of additional monitoring is a major appeal of the program, he mourns the loss of its social aspect.
“There’s a sense of community as a result of a shared experience,” he said. “They (hospital officials) say they need to expand Phase II, and that makes sense. That’s what insurance covers. But does it have to be at the expense of this program?”
CPMC has been under the microscope recently. A not-for-profit affiliate of Sutter Health, a Northern California hospital network, it wants to close the Mission District’s St. Luke’s, a 229-bed money-losing facility, and replace it with a new 80-bed one. Most of St. Luke’s patients are on Medi-Cal or Medicare, and many of them are immigrants, poor or elderly. Patients, city officials and union leaders are calling for Sutter Health to pledge to keep the hospital open for at least 20 years after it is rebuilt as part of negotiations for the company’s $2.5 billion development plan, which includes a 555-bed hospital on Cathedral Hill.
Grossman said that now that the Phase III classes are over, he will likely ride a recumbent bike in his basement and go for long walks, but that he was “depressed as heck about it.”
“I’m a very structured guy,” he said. “If left to my own devices, I might not do it.”