In the mid-19th century, the rise in development and population of San Francisco necessitated the establishment of a public heath care system, primarily manifesting as public county hospitals. From 1855 through the early 20th century, the city set up and disbanded several temporary hospitals to care for the indigent sick through epidemics of cholera, smallpox, tuberculosis, and other infectious diseases.
The first City and County Hospital on Potrero Street opened in 1872, and consisted of six two-story wooden buildings. This hospital survived the 1906 earthquake and cared for many of the injured. However, rats roaming the ruins of the city brought led to outbreaks of plague, which surfaced in the hospital as well. In 1907 the hospital was condemned, demolished, and burned.
In 1878, the hospital negotiated an agreement with two medical schools, California Medical College (later to become UCSF) and Cooper Medical College, for their medical students to staff the hospital. In 1960, the hospital signed its first contract with University of California, beginning the long-standing cooperation that both institutions continue to benefit from to this day.
The new San Francisco City and County Hospital, of which buildings 1, 9, 10, 20, 30, and 40 are still standing, was completed in 1915. Building 100 was added in 1917, and Buildings 80 and 90 were added in 1938. The hospital campus consisted of separate wards, hospitals, and support systems, and at the time was the city’s most modern and comprehensive complex.
The hospital’s location on Potrero Avenue was far the city center, which necessitated the development of a city-wide Emergency Service in 1895. By the end of the 1930s, all major emergencies were taken by ambulance to Mission Emergency at SFGH.
The anti-Vietnam War protests and the bourgeoning drug culture of the 1960s brought overdoses, psychiatric problems, injuries and violent crime to San Francisco, with cases chiefly brought to SFGH. This led to the development of a full trauma service at SFGH, and the hospital received its Federal Trauma Center designation in 1972. Today, ZSFG is the only Level I trauma center in Northern California.
The advancement of medical science brought with it major changes to hospital care in the mid-20th century, changing the focus of inpatient care from chronic to acute disease. The pavilion style wards were outdated and inefficient, and the hospital was overcrowded and in constant need of maintenance. In 1964, voters overwhelmingly supported a bond to build a new hospital, which was completed in 1976.
The advent of Medicare/Medicaid, new Federal regulation requirements, lack of adequate funding, and staffing shortages led to a time of difficulty for SFGH from the 1960s to the 1980s. Overworked staff engaged in activism to improve conditions for both staff and patients, including organizing the first nursing strike in the nation’s history in 1966. These issues led to many other strikes and confrontations between staff and administration.
The effect of AIDS on San Francisco’s community and history is pervasive and lasting. In the height of the epidemic, there was one case of AIDS per 1,000 people in San Francisco — more cases per capita than anywhere else in the country. No other hospital was willing or able to care for HIV patients, but SFGH welcomed these patients even as others turned them away.
Clinicians at SFGH developed what became known as the “San Francisco model” for the care of AIDS and HIV-positive patients. The model was first and foremost based on the idea that patients should be treated with respect and compassion, two qualities that had been missing in the initial fear and uncertainty surrounding the epidemic. The model emphasized providing various health and social services in one facility while also working with community organizations and the Department of Public Health. The “San Francisco model” developed at SFGH soon became the global standard of HIV patient care, and it remains so to this day.
Ward 86 at SFGH was the first dedicated HIV clinic in the U.S., and ward 5B that followed was the first inpatient unit dedicated to HIV/AIDS care. Ward 86 and the San Francisco model were unique in recognizing the social context of HIV/AIDS, including the fact that such a stigmatized disease primarily affected already stigmatized communities — particularly gay men, but also those dealing with homelessness, mental illness, poverty, or substance abuse.
SFGH continues to lead the way in treatment for HIV/AIDS. In 2007, SFGH became the first hospital to routinely offer HIV testing to patients in the emergency room. In 2010, SFGH’s Ward 86 launched the first “universal treatment” initiative, which works to provide antiretroviral therapy to every HIV-positive person, regardless of the stage of the disease. Researchers at SFGH and UCSF are now looking to the future and working to create a cure and a vaccine for HIV.
In 2008, an overwhelming 84 percent of San Francisco voters passed Proposition A, approving $887 million in bonds to build a new acute care hospital and trauma center. In appreciation of their gift of $75 million, Dr. Chan and Mark Zuckerberg’s names were added to the current hospital name to become Priscilla Chan and Mark Zuckerberg San Francisco General Hospital and Trauma Center.
Today, ZSFG is a one of the nation’s top hospitals, serving 100,000 patients each year with inpatient, outpatient, emergency, diagnostic and psychiatric services 24 hours a day. The new acute care hospital, completed in 2015, will help ZSFG continue to provide comprehensive, patient-centered health care for San Francisco and the surrounding communities.