A major Chicago-based medical association has decided to move its $40 million convention out of San Francisco due to safety issues for its conventioneers.

The neighborhood’s open drug use and tent encampments, among other issues, are what allegedly prompted the unidentified medical group to call it quits with SF, even though the city spends approximately $300 million to help the continuing crisis.

“It’s the first time that we have had an out-and-out cancellation over the issue, and this is a group that has been coming here every three or four years since the 1980s,” Joe D’Alessandro, president and CEO of S.F. Travel, tells San Francisco Chronicle’s Matier and Ross.

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Fears about other groups moving their conventions out of the area are now a real concern. Gatherings at Moscone Center—which is currently undergoing a major renovation mucking up the SoMa neighborhood—bring in roughly $1.7 billion into the local economy.

After San Francisco’s tourism industry took a hit in 2017, S.F. Travel also pointed the finger at the city’s most deliberated issue.

“[Tourists] wonder why does one of the wealthiest cities in one of the wealthiest states have streets that look like this?” D’Alessandro said in an interview with CBS SF. “Why are there people living on the streets in these conditions?”

But is the homeless crisis the sole reason why a major medical outfit would move their convention out of San Francisco? One other factor could be Central Subway construction, which has shut down part of Fourth Street bounding Moscone Center.

And the aforementioned Moscone Center renovation, which has been underway since early 2017, has hindered both foot and vehicular traffic along Fourth Street and Howard Street, affecting access to Moscone’s three buildings.

Another reason why the unidentified medical group could have left the city—skyrocketing costs. In 2017, both Apple and Facebook moved their yearly conferences out of San Francisco and to the McEnery Convention Center in San Jose, reportedly due to costs.

“[I]t has become very expensive for an independent developer to spend the week in San Francisco for WWDC,” noted a 2017 Tech Crunch article. “Given the size of the conference and all the side events, hotel rooms had become very expensive.”