Published on June, 2019 in Features by Jessica Zimmer
From its perch at 1050 Wisconsin Street the Caleb G. Clark Potrero Hill Health Center (PHHC) serves a wide range of City residents, including long-standing Hill patients, municipal employees, and new clients from the Excelsior and Tenderloin.
“This health care center stands out because patients feel like they’re coming home. Many patients at the center from Potrero Hill have been coming here for years. When the [neighborhood] kids see people from the center on the street, they say hello. It’s about trust,” said Evita Mullins, PHHC’s nurse manager.
PHHC has a patient list of about 2,000 San Franciscans. It serves between 50 and 60 people a day, offering primary health care, general dentistry, in-home visits for chronically ill clients, and treatment for HIV/AIDS and related medical needs. The center also provides eye care, podiatry, and mental health services, as well as assistance navigating insurance forms and applying for social services.
Roughly a year ago, PHHC partnered with the Potrero Hill Neighborhood House to offer amenities at the Nabe’s 953 De Haro Street location. This month the center will introduce classroom programs about nutrition and dental hygiene to neighborhood institutes, including at Starr King and Daniel Webster elementary schools.
PHHC collaborates with the University of California San Francisco (UCSF) School of Medicine to train students at the center. High school juniors and seniors complete health internships at the facility through the nonprofit San Francisco YouthWorks.
“The demographics of the area have changed a lot, but we continue to serve patients through a holistic care approach. That’s just as we did when the center started,” said Mullins.
PHHC is run by the San Francisco Department of Public Health (DPH), with patient services paid for by Medi-Cal, Medicare, or Healthy San Francisco. Uninsured medically indigent adults are also eligible for treatment.
According to Roxana Castellón, DPH primary care director of operations, most center patients reside in seven zip codes. Approximately 390 live in Dogpatch and on the Hill, 339 in Bayview-Hunters Point, 373 in the Inner Mission and Bernal Heights, 257 in Excelsior, Ingleside, and Crocker-Amazon, 173 in Visitacion Valley and the Sunnydale Developments, 122 South-of-Market and Hayes Valley, and 90 in the Tenderloin and adjacent areas.
“The demographics of the neighborhood have changed a lot. Many patients who used to live on the Hill have moved to other neighborhoods throughout the City or into neighboring counties. Today, the majority of PHHC patients come here because they have either received care for many years spanning generations in their family or they are assigned (by DPH) to the center as their medical home,” said Castellón.
Mullins said transitory people without shelter also receive PHHC services. “Some homeless people are assigned to this center because their emergency address is close by. Others come to us for the food pharmacy. When we identify a patient as homeless, we send them mailers and text reminders to come in for services,” said Mullins.
PHHC has a staff of about 25, including three doctors, two nurses, five medical assistants, dental aides and hygienist, podiatrist, behavioral health team, nutritionists, pharmacists, psychiatrist, and front office staff.
At the Nabe PHHC offers flu shots and prenatal care. It runs a monthly diabetes support group with a free healthy lunch; a staff member visits every Wednesday to do blood pressure readings.
“All of those things have been good. Another thing we want to work on with PHHC is reaching out to the Hill’s transitional age youth between the ages of 16 and 24. There’s a lot of young people who are about to become homeless due to housing costs and their skill sets. We’re working to be inclusive. The goal is to get them signed up for health care at a center in the neighborhood where they live,” said Edward Hatter, the Nabe’s executive director.
Juhi Varshney, a second-year UCSF medical student, is currently doing a medicine rotation at PHHC, visiting every two weeks. “Potrero Hill is a really integrated clinic that sees a lot of patients in vulnerable circumstances. My rotation here is special because I’ve had the chance to follow some patients longitudinally,” said Varshney. PHHC is “lovely,” the staff are “kind and thoughtful. They have meaningful relationships with their patients.”
On her first day at the clinic, Varshney made a home visit to a patient with a chronic illness. “The nurse and I walked a couple of streets down. I’d never really gotten to walk the neighborhood before. It was welcoming to be invited to a patient’s home and so helpful for my learning. I got to meet her dog and see her in the context where she lived,” said Varshney.
According to Varshney, PHHC patients often have a history of trauma, chronic pain, and substance use. “I think it takes providers who are committed to caring for the long haul. It takes time, trust, and a lot of work to find a place of constant support for patients’ health. The process of healing is not a linear path. Our patients deserve a place where they feel safe and cared for, where people will be there for them for years,” said Varshney.
As with all DPH facilities, PHHC provides translation services. Center staff speak Spanish, Chinese, and Tagalog.
Jessica Antonio, language access coordinator for the Filipino Community Center, an Excelsior-based nonprofit organization, said it’s mandatory for DPH to provide care in the language in which a patient feels comfortable communicating. “The Excelsior is home to one of the last of the Filipino immigrant communities in the City. When the majority of an immigrant community has been forced out, there’s even more of a need to have centers that cater to the existing community. Smaller health care centers make care more accessible,” said Antonio.
“For many of our communities, accessing health care and treatment services can be challenging, especially for those seeking to address their mental health and substance use needs and members of communities historically underserved by our health systems,” said Linda Walubengo, senior director of program administration and operations at the San Francisco AIDS Foundation, a nonprofit that focuses on education and advocacy for people living with AIDS. “Programs offered in the community in ways that allow people to readily access them are important, as they allow people to get the services they need and are ready for. The goal needs to be centering on the person, not their illness or ability to navigate a complex health care system.”
In the next year, PHHC expects to engage two or three more DPH doctors. A substance abuse counselor, who is a full-time UCSF employee, is stationed at the center. PHHC is negotiating with Starr King and Daniel Webster to arrange popup dental screenings at the elementary schools, providing students with basic dental care and referrals for more intensive services. PHHC is also developing class field trips to the clinic.
“The reason things are changing is because some programs are shifting from pilot programs to permanent programs. We’ve had committees working to identify the patients’ needs for a while. It’s a really exciting time for the center,” said Mullins.
Hatter supports having a clinic at the Potrero Annex-Terrace housing complex, home to 1,280 residents. “Part of the Hope-SF proposal was that there were supposed to be wellness centers onsite in the four large housing complexes that they’re building. Now DPH is backing down on putting those centers in,” said Hatter.
In 1972, prompted by poor access to affordable health care, a movement arose on the Hill to ensure that the community received adequate services. Long-time Hill resident, Jim Queen, formed the Potrero Hill Community Government (PHCG), an advocacy group that focused on Annex-Terrace. The effort to establish PHHC started through PHCG’s health committee, which was primarily composed of African-American Annex-Terrace tenants.
Annie Blue, an Annex-Terrace resident, served as the committee’s first chairperson. Blue worked with her neighbors, including Vera Blue, Rebecca Purnell, Ruth Wellington, Norma Jackson, Francis Beals, and Sam Scott, to lobby DPH to build the center.
“Elouise Westbrook was also critical to making this happen,” said Queen.
Hatter, who is Enola Maxwell’s grandson, recalled that Maxwell, the Nabe’s long-time executive director, was a center advocate. “So was Rhonda Carchant, another one of the lead activists who worked to get the clinic opened,” said Hatter.
According to Queen, PHCG insisted on having community outreach workers. “The center needs that kind of interaction between outreach workers and public housing residents to get patients registered for care,” said Queen.
PHCG conducted a survey of low-income Hill residents who might use the center and identified policymakers to lobby. Long-time Hill resident, Art Agnos, who was then an aide to California State Assemblyman Leo McCarthy, also a Hill resident, joined the cause. On December 13, 1973, Agnos was shot in the neighborhood by one of the “Zebra Killers,” four Black men who targeted European-Americans. In response, Agnos fought even harder to establish the center.
PHCG demonstrated to then-director of DPH, Dr. Francis Curry, that the Hill was medically underserved. PHHC opened its doors on January 17, 1976, named for Caleb G. Clark, an African-American social worker who worked at the center in its early years who died of kidney disease soon after it opened.
PHHC’s first medical director was Dr. Robert Ross, a family health resident at Zuckerberg San Francisco General Hospital and Trauma Center (ZSFGH). Ross established the center’s ties to ZSFGH’s family health residency program and UCSF’s medical school. In July 27, 1983, Ross was shot and killed at PHHC by a widower of a sister of one of the center’s patients.
Dr. Michael Drennan became the center’s next medical director, seeing it through tumultuous times. In 1987, the federal government, which’d been funding PHHC, withdrew its support. Agnos, who served as Mayor from 1988 to 1992, ensured that PHHC continued to receive municipal monies. Throughout Agnos’s term and following it, the City suffered budgetary cutbacks, putting pressure on the facility to close. In 2000, Public Health Director Dr. Mitchell Katz wanted to shutter PHHC and sell its building. Opposition from Hill residents prompted Roma Guy, a social worker and head of DPH’s Health Commission, DPH’s governing body, to overrule Katz.
Queen remembered Drennan as an exemplary leader who helped the center develop an array of innovative programs. “(He) increased outreach to the community, with community health workers Sandy Porter and John Murphy, and enriched health professionals’ on-site training…became the central health and social care institution for Potrero Hill,” said Queen.
Other past center medical directors included Dr. Jan Gurley, who succeeded Drennan, and Dr. Justin Morgan, who was medical director in 2017. Dr. Angela Miller became full-time medical director in February 2019.
In 2010, DPH extended the rear of the building to add two exam rooms, a conference area, and three offices. In 2014, Precita Eyes, an artist collective based in Bernal Heights, completed the Bridge Housing Mural Project on the facility’s south side in time for its 40th anniversary. The mural, painted by Susan Cervantes, Suaro Cervantes, and Fred Alvarado, features a shining eye that watches over the neighborhood.
In 2016, the center’s medical records room was converted into office space for the behavioral health lab staff. In 2017, the center’s nursing station was remodeled to include new desks, computer stations, sinks and flooring. In 2018, the building upgraded its heating system. The facility’s laboratory is currently being remodeled.
Many of the center’s patients live miles away from it. The shift began in the early 1990s, when PHHC was assigned patients from far-away neighborhoods. Queen and Agnos said gentrification is the primary reason why fewer people on the Hill are PHHC patients.
“We’ve emptied out a lot of the neighborhood in the part of Potrero Hill that this health clinic was aimed toward. When the Potrero Annex and Terrace were full and bustling, plenty of people needed the clinic’s services,” said Agnos.
Agnos said low neighborhood enrollment makes the center less compelling to people unfamiliar with its history. “They look on a map and see its proximity to ZSFGH. It seems like such a short distance. But they don’t see the hill. They don’t see that it’s impossible for the average patient at this health center to reach ZSFGH. There is no direct route,” said Agnos.
Mullins added that ZSFGH is more oriented to emergency services than long-term primary care.
According to Dr. Jonathan Rapp, a physician specialist who worked at the center from 1991 to 2017, “You have to have people advocating for services where the needs are.” Rapp said even when demand for services was high, PHHC never refused to care for a patient for an inability to pay.
Queen said the center’s future is uncertain. “San Francisco is no longer affordable for working-class people. There’s hope that PHHC will see higher enrollment when the Potrero Annex and Terrace remodels are finished. Hope-SF, a public housing revitalization project involving the remodel of Hunters View, Sunnydale-Velasco, Potrero Terrace and Annex, and Alice Griffith developments, will increase the overall number of units in Potrero Hill. This should increase the number of eligible patients. These residents will be able to remain PHHC patients,” said Queen. “The center, the Head Start program, and the Nabe are the best programs that have developed in the neighborhood. The center became a place that everybody could relate to. Residents here have fought for it for years. They feel ownership of the center. PHHC has become a centerpiece. People have pride in it. When you walk into the place, it still has that feeling.”
“The center provides individual care that goes beyond ordinary care. You don’t get this kind of care at the ER. They patch you up and send you out. This center goes far more in depth. The staff at PHHC goes beyond the initial ailment. Here they listen to the community, absorb its culture, and help residents make a fuller recovery,” said Agnos.